摘要
目的:分析慢性阻塞性肺疾病(COPD)患者肺康复干预后2年内生存及预后的影响因素,评价不同强度有氧运动对COPD患者的康复疗效,探讨依照稳定期COPD患者的肺功能等级选择适宜的肺康复策略。方法:收集上海市第四康复医院呼吸科门诊及住院治疗且随访的COPD患者529例,所有患者均给予:①COPD的内科常规治疗,包括支气管舒张剂、激素和β2-受体激动剂(FEV1占预计值百分比<50%且有临床症状的患者联合应用这两者)、其他祛痰止咳类药物。②肺康复宣教,包括COPD相关知识、肺康复理念、戒烟、氧疗、药物应用及营养等,每月1次。③有氧呼吸操训练,包括缩唇呼吸及腹式呼吸训练,每周5次,每次20 min。④运动训练,采用随机区组设计的由低至高不同强度的有氧运动。治疗时间为20周,治疗后进行2年的生存情况随访。调查影响其生存率的因素,应用Cox回归模型对COPD患者肺康复干预后2年内生存率及预后的影响因素进行分析。结果:①对529例患者2年的随访中,COPD 3级死于呼吸系统疾病者38例,COPD 4级死于呼吸系统疾病者43例。②单因素分析结果发现,肺功能等级、BODE指数、有氧运动强度及COPD急性发作对COPD患者肺康复干预后2年内生存率有明显影响(P<0.05),而年龄、性别及无创呼吸机的使用对其肺康复干预后2年内生存率无明显影响(P>0.05);Cox回归分析发现,肺功能等级、BODE指数、有氧运动强度及COPD急性加重发作次数对COPD患者肺康复干预后2年内生存率有明显影响(P<0.05),而无创呼吸机的使用对其肺康复干预后2年内生存率无明显影响(P>0.05);其中,肺功能等级、BODE指数、急性加重发作次数是影响COPD患者预后的危险因素,而有氧运动是影响COPD患者预后的保护因素。③由COPD患者的生存及风险函数图推测,COPD患者的生存曲线:高强度有氧运动干预>中等强度有氧运动干预>低强度有氧运动干预;COPD患者的累积风险:高强度有氧运动干预<中等强度有氧运动干预<低强度有氧运动干预。结论:肺功能越差、BODE指数越高、急性加重发作次数越多的COPD患者死亡率越高,而有氧运动能提高COPD患者2年内生存率,改善其预后,其中高强度有氧运动患者获益最多。
Objective: To evaluate the rehabilitation effect of different intensity aerobic exercise on patients with chronic obstructive pulmonary disease(COPD), and explore an appropriate pulmonary rehabilitation strategy for COPD patients with different degrees of pulmonary function in alleviating period. Methods: A total of 529 COPD patients were from the respiratory department of Shanghai Fourth Rehabilitation Hospital. All patients were given the treatments: ① Routine medical treatment of COPD, included bronchodilator, hormones and β2 receptor agonist(the patients whose FEV1 accounted for less than 50% of the predicted value and having clinical symptoms were treated with inhaled hormones and β2 receptor agonist), and other expectorant and cough-relieving drugs. ② Pulmonary rehabilitation education, included knowledge of COPD, pulmonary rehabilitation idea, smoking cessation, oxygen therapy, rational use of drugs and balanced nutrition, once a month. ③ Aerobic respiratory exercises, included lip contraction breathing and abdominal breathing training, 5 times a week, 20 minutes each time. ④ Aerobic exercise training, limited aerobic exercise with different intensity from low to high using randomized block design. All patients completed aerobic exercise of different intensity for 20 weeks,and postoperative life quality, treatment, and survival time of the patients were followed up for 2 years. The factors affecting survival were investigated, and Cox regression analysis was used to analyze various factors affecting the survival of COPD patients. Results: ①The 38 cases of COPD grade III died of respiratory diseases, and 43 cases of COPD grade Ⅳ died of respiratory diseases. ② According to the single factor correlation analysis, pulmonary function grade, BODE index, aerobic exercise intensity and frequency of acute episodes were the factors influencing the survival rate of COPD patients within two years after 20-week pulmonary rehabilitation(P<0.05), but sex, age, and the use of noninvasive ventilator had no obviously effect on survival rate of the COPD patients(P>0.05). ③From multifactor correlation analysis, pulmonary function grade, BODE index, aerobic exercise intensity and frequency of acute episodes were the factors influencing the survival rate of COPD patients within two years after 20-week pulmonary rehabilitation(P<0.05), but the use of noninvasive ventilator had no obviously effect on survival rate of the COPD patients(P>0.05). Furthermore,pulmonary function grade, BODE index, and frequency of acute episodes were the risk factors affecting the prognosis of COPD patients, and aerobic exercise was the protective factor affecting the prognosis of COPD patients. ④ According to the survival curve of COPD patients, the survival curve of COPD patients undergoing high strength aerobic exercise intervention was higher than COPD patients undergoing middle strength aerobic exercise intervention, and the survival curve of COPD patients undergoing low strength aerobic exercise intervention was the least. On the contrary, the cumulative risk of COPD patients undergoing high strength aerobic exercise intervention was lower than COPD patients undergoing middle strength aerobic exercise intervention, and the cumulative risk of COPD patients undergoing low strength aerobic exercise intervention was the most. Conclusion: The worse the pulmonary function,the higher the BODE index, and the more times of acute exacerbations, the higher the mortality rate of COPD patients. In addition, aerobic exercise can improve the survival of COPD with chronic obstructive pulmonary disease within two years. What’s more, the patients with high intensity aerobic exercise benefit the most.
作者
许轶明
沈宏华
杜井波
任蕾
XU Yiming;SHEN Honghua;DU Jingbo;REN Lei(Shanghai Fourth Rehabilitation Hospital,Shanghai 200040,China)
出处
《康复学报》
CSCD
2019年第6期21-27,共7页
Rehabilitation Medicine
基金
国家自然科学基金项目(81770085)
上海市静安区卫生计生系统医学科研课题(2018MS21)
广东省适宜技术研发与推广应用项目(16CR4003A)
关键词
慢性阻塞性肺疾病
有氧运动
COX回归分析
chronic obstructive pulmonary disease
aerobic exercise
Cox regression analysis
