目的 探讨呼吸导引康复技术联合吸气肌训练在慢性阻塞性肺疾病(COPD)稳定期患者中的应用价值.方法 选择2022-01-01-2023-01-30河南中医药大学第一附属医院收治的90例COPD患者作为研究对象,根据组间基线资料均衡可比的原则,随机数字表法分为3组,分别为呼吸导引组、吸气肌训练组和联合组,每组各30例,所有患者均实施西医基础治疗和健康教育,呼吸导引组在此基础上实施呼吸导引康复技术,吸气肌训练组在此基础上实施吸气肌训练,联合组则在此基础上实施呼吸导引康复技术联合吸气肌训练.比较3组患者呼吸困难程度[改良呼吸困难指数(modified medical research council,mMRC)量表]、肺功能[第1秒用力呼气容积占预计值百分比(FEV1％)、用力肺活量(FVC)和一氧化碳弥散量占预计值百分比(DLCO％)]、慢性阻塞性肺疾病评估测试(CAT)评分、圣乔治呼吸问卷(SGRQ)评分、6分钟步行距离(6MWD)、健康调查简表(the MOS item short from health survey,SF-36)评分、临床症状积分和慢性阻塞性肺疾病急性发作(AECOPD)次数.结果 干预后,3组患者呼吸困难mMRC分级、CAT评分、SGRQ评分、临床症状积分均较干预前降低,均P＜0.05;FEV1％、FVC、DLCO％、6MWD、SF-36量表评分均较干预前升高,均P＜0.05.干预后,联合组患者呼吸困难mMRC分级低于呼吸导引组和吸气肌训练组,均P＜0.05;联合组患者FEV1％为(85.18±9.03)％,高于呼吸导引组(78.34±9.33)％和吸气肌训练组(77.37±8.46)％,F=7.101,P=0.001;FVC 为(2.35±0.37)L,高于呼吸导引组(2.05±0.22)L 和吸气肌训练组(2.10±0.29)L,F=8.969,P＜0.001;DLCO％为(78.78±8.05)％,高于呼吸导引组(72.28±7.35)％和吸气肌训练组(70.26±7.58)％,F=9.953,P＜0.001;6MWD 为(386.39±15.73)m,高于呼吸导引组(313.48±14.56)m 和吸气肌训练组(310.57±13.04)m,F=256.012,P＜0.001;SF-36量表评分为(86.39±7.85)分,高于呼吸导引组(73.48±8.04)分和吸气肌训练组(75.57±8.47)分,F=21.447,P＜0.001.联合组患者CAT评分为(12.59±2.17)分,低于呼吸导引组(17.08±2.74)分和吸气肌训练组(16.85±3.13)分,F=25.903,P＜0.001;SGRQ评分为(36.85±6.26)分,低于呼吸导引组(50.71±9.52)分和吸气肌训练组(47.28±6.18)分,F=27.448,P＜0.001;临床症状积分为(4.45±1.07)分,低于呼吸导引组(6.62±1.73)分和吸气肌训练组(6.48±1.39)分,F=21.641,P＜0.001.随访期间联合组患者急性发作0～4(2.43±1.37)次,低于呼吸导引组0～9(5.33±2.19)次和吸气训练组0～7(4.77±2.36)次,差异有统计学意义,F=17.449,P＜0.001.结论 呼吸导引康复技术和呼吸肌训练均是COPD稳定期患者肺康复的有效方法,两者联合应用可进一步降低患者呼吸困难的严重程度,改善患者肺功能,对患者运动耐力和生活质量的提高均有积极的作用,安全有效.
Influence of breath-guided rehabilitation technique combined with inspiratory muscle training on patients with stable chronic obstructive pulmonary disease
Objective To investigate the application value of breath-guided rehabilitation technique combined with inspirato-ry muscle training in patients with chronic obstructive pulmonary disease(COPD)in stable stage.Methods A total of 90 patients with COPD admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from January 1,2022,to January 30,2023 were selected as the study objects.According to the principle of balanced comparability of baseline data between groups,they were divided into three groups using random number table method,namely respiratory guidance group,inspiratory muscle training group and combined group,with 30 cases in each group.All patients were given basic Western medicine treatment and health education.The breath-guided group was given breath-guided rehabili-tation technology on this basis,the inspiratory muscle training group was given inspiratory muscle training on this basis,and the combined group was given breath-guided rehabilitation technology combined with inspiratory muscle training on this basis.The degree of dyspnea[modified medical research council,(mMRC)scale],lung function[forced expiratory volume in the first second(FEV1％),forced vital capacity(FVC)and diffusing capacity for carbon monoxide％predicted(DLCO％)],chronic obstructive pulmonary disease assessment test(CAT)score,St.Georges respiratory questionnaire(SGRQ)score,6-minute walking distance(6MWD),medical outcomes study short form health survey(SF-36)score,clinical symptom score,and the number of acute exacerbations of chronic obstructive pulmonary disease(AECOPD)were compared among the three groups.Results After intervention,the mMRC dyspnea grade,CAT score,SGRQ score,and clinical symptom score of the three groups of patients were all lower than those before intervention,with all P values＜0.05;FEV1％,FVC,DLCO％,6MWD,and SF-36 scale scores were all higher than those before intervention,with all P values＜0.05.After intervention,the mMRC dyspnea grade of the combined group was lower than that of the re-spiratory guided group and the inspiratory muscle training group,with all P values＜0.05;the FEV1％of the combined group was(85.18±9.03)％,which was higher than(78.34±9.33)％in the respiratory guided group and(77.37±8.46)％in the inspiratory muscle training group,F=7.101,P=0.001;the FVC was(2.35±0.37)L,higher than(2.05±0.22)L in the respiratory guided group and(2.10±0.29)L in the inspiratory muscle training group,F=8.969,P＜0.001;the DLCO％was(78.78±8.05)％,higher than(72.28±7.35)％in the respiratory guided group and(70.26±7.58)％in the inspiratory muscle training group,F=9.953,P＜0.001;the 6MWD was(386.39±15.73)m,higher than(313.48±14.56)m in the respiratory guided group and(310.57±13.04)m in the inspiratory muscle train-ing group,F=256.012,P＜0.001;the SF-36 scale score was(86.39±7.85)points,higher than(73.48±8.04)points in the respiratory guided group and(75.57±8.47)points in the inspiratory muscle training group,F=21.447,P＜0.001.The CAT score of the combined group was(12.59±2.17)points,lower than(17.08±2.74)points in the respir-atory guided group and(16.85±3.13)points in the inspiratory muscle training group,F=25.903,P＜0.001;the SGRQ score was(36.85±6.26)points,lower than(50.71±9.52)points in the respiratory guided group and(47.28±6.18)points in the inspiratory muscle training group,F=27.448,P＜0.001;the clinical symptom score was(4.45±1.07)points,lower than(6.62±1.73)points in the respiratory guided group and(6.48±1.39)points in the inspiratory muscle training group,F=21.641,P＜0.001.During follow-up,the number of acute exacerbations in the combined group was 0-4(2.43±1.37)times,lower than 0-9(5.33±2.19)times in the respiratory guided group and 0-7(4.77±2.36)times in the inspiratory muscle training group,with a statistically significant difference,F=17.449,P＜0.001.Conclusions Breath-guided rehabilitation technique and respiratory muscle training are both effective methods for pulmonary rehabilitation in stable COPD patients,and the combined application of the two can further reduce the severity of dyspnea,improve the lung function of patients,and improve the exercise endurance and quality of life of patients,which is safe and effective.
chronic obstructive pulmonary diseasestable periodbreath-guided rehabilitation technologyinspiratory mus-cle trainingactivity endurancequality of life
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