摘要
背景 我国慢性阻塞性肺疾病(COPD)患者数量巨大,呼吸康复训练作为COPD患者稳定期管理的重要部分,可有效提高患者肺功能及生活质量,减少家庭及社会负担,国外有研究数据显示远程医疗管理下实施呼吸康复可提高患者的肺功能和生活质量(QOL)评分,但是国内,尤其是西部尚缺乏相关实践.目的 评估通过远程医疗管理进行呼吸康复训练与传统治疗相结合对老年中重度COPD患者通气能力及肺功能的影响.方法 本研究为前瞻性随机对照研究,连续性纳入 2021 年 6 月—2022 年 6 月就诊于四川省第四人民医院及5个联合社区的COPD患者,采用随机数字表进行简单随机分组,将患者分为试验组和对照组.对照组接受传统的长期规律吸入支气管扩张剂及口服药物治疗,试验组在对照组治疗方案的基础上采用远程医疗管理.对两组患者进行为期 6 个月的研究,分别在基线时及干预 1、3、6 个月后记录患者的肺功能、博格评分(Borg评分)、6 min步行试验(6MWT)、QOL评分.结果 研究对象分为对照组(72 例)和试验组(73 例),两组患者的性别、年龄及基线时肺功能[第 1 秒用力呼气末容积占预计值百分比(FEV1%pred)及第 1 秒用力呼气末容积与用力肺活量(FVC)的比值(FEV1/FVC)]比较,差异均无统计学意义(P>0.05).时间和组间对FEV1%pred、FEV1/FVC、6MWT水平、QOL评分中呼吸困难、情绪存在交互作用(P<0.05).干预 1、3、6 个月后,试验组FEV1%pred、FEV1/FVC、Borg评分、6MWT、QOL评分优于对照组(P<0.05);干预3、6个月后,试验组FEV1%pred、FEV1/FVC、Borg评分、6MWT、QOL评分优于干预后1个月时(P<0.05).结论 采用远程医疗管理对老年中重度COPD稳定期患者进行呼吸康复,干预3、6个月后能有效改善该类患者肺功能,提高生活质量及生存质量.
Abstract
Background The number of chronic obstructive pulmonary disease(COPD)patients in China is huge,and respiratory rehabilitation training,as an important part of the management of COPD patients in the stabilization period,can effectively improve their lung function and quality of life,as well as reduce the burden on their families and society.Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients,however,there is a lack of relevant practice in China,especially in the west.Objective To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.Methods This study was a prospective randomized controlled study,enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022.The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table.The control group received traditional long-term regular inhalation bronchodilator and oral medication,and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group.A six-month study was conducted on two groups of patients,lung function,Borg score,6MWT,and quality of life score(QOL score)were recorded at 1 month before and 1,3,6 months after intervention.Results The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group,and there was no significant difference in gender,age and lung function at baseline[the forced expiratory volume in one second/predicted value ratio(FEV1%pred),and the ratio of the forced expiratory volume in one second to the forced vital capacity(FEV1/FVC)]between the two groups(P>0.05).There was an interaction between time and group for dyspnea and mood in FEV1%pred,FEV1/FVC,6MWT level and QOL score(P<0.05).After 1,3,and 6 months of intervention,FEV1%pred,FEV1/FVC,6MWT,Borg score,and QOL score of the experimental group were better than those of the control group(P<0.05);FEV1%pred,FEV1/FVC,Borg score,6MWT,and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group(P<0.05).Conclusion The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function,quality of life and the quality of survival of this group of patients after 3,6-months intervention.
基金项目
四川省科学技术厅软科学项目(2021JDR0183)
维普
万方数据