| 摘要: |
| 目的观察肺康复护理在慢性阻塞性肺疾病（COPD）急性加重患者中的应用效果。方法将135例COPD急性加重住院患者分为常规组（64例）和肺康复组（71例），两组均给予常规治疗，肺康复组在常规治疗基础上于住院期间即开始肺康复护理，并延续12周的随访护理。比较两组平均住院时间、住院费用、抗生素使用时间；比较治疗前后观察两组自我评估测试（CAT）评分、改良英国呼吸困难指数（mMRC）及血清TNF-α和IL-6水平；比较随访周期内常规组和肺康复组急性发作次数和再入院次数。结果肺康复组与常规组比较，住院时间、抗生素使用时间更短，住院费用更低（均P＜0.05）。治疗前两组CAT评分、mMRC、血清TNF-α及IL-6水平差异均无统计学意义（均P＞0.05）；常规组和肺康复组治疗后CAT评分为25.70±4.69、22.13±4.27，mMRC为2.41±0.73、2.10±0.66，血清TNF-α水平为（5.94±2.04）、(5.12±1.89)pg/ml，IL-6水平为（4.29±1.04）、(3.85±1.07)pg/ml，均较治疗前降低（P＜0.05或0.01）；治疗后肺康复组与常规组比较，CAT评分、mMRC降低，血清TNF-α、IL-6水平下降，差异均有统计学意义（P＜0.05或0.01）。随访周期内，急性加重次数及再住院次数肺康复组较常规组明显减少（P＜0.05）。结论对COPD急性加重的住院患者实施肺康复，可缩短患者住院时间，降低医疗成本，改善生存质量、症状及运动能力，减少急性加重对肺功能的影响，改善患者急性加重后的炎症反应，降低短期再入院的风险。 |
| 关键词: 肺康复 慢性阻塞性肺疾病 急性加重 综合评估 |
| DOI：10.12056/j.issn.1006-2785.2017.39.23.2017-375 |
| 分类号: |
| 基金项目:浙江省中医药科研基金计划项目（2016ZA160） |
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| Application of pulmonary rehabilitation for patients with acute exacerbations of chronic obstructive pulmonary disease |
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Hangzhou First People's Hospital
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| Abstract: |
| Objective To assess the application of pulmonary rehabilitation for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods One hundred and thirty five patients with AECOPD were randomly assigned to two groups: patients in PR group (n=71) received simultaneous pulmonary rehabilitation and 12-week follow-up rehabilitation in addition to conventional treatment, and patients in control group (n=64) received conventional treatment only. The length of hospital stay, cost of hospitalization and therapeutic course of antibiotic were compared between the two groups. The COPD Assessment test (CAT) score, modified British Research Council (mMRC) score, 6-minute walk distance (6MWD) and FEV1% were evaluated, and serum TNF-α and IL-6 levels were measured and compared in two groups before and after treatment. The frequency of acute exacerbation and readmission in the follow-up period were compared between two groups. Results The length of hospital stay，cost of hospitalization and therapeutic course of antibiotics in PR group were less than those in control group (P＜0.05). There were no significant differences in CAT score, mMRC, 6MWD, FEV1%, and serum TNF-α and
IL-6 levels between two groups before treatment (P ＞0.05). After treatment the CAT score and mMRC in PR group were significantly higher than control group [(25.70±4.69) vs. (22.13±4.27) and（2.41±0.73）vs (2.10±0.66), P＜0.05], serum TNF-α and IL-6 levels were significantly lower than those in control group [(5.94±2.04）pg/ml vs. (5.12±1.89)pg/ml and (4.29±1.04) pg/ml vs (3.85 ±1.07)pg/ml, P ＜0.05], the 6MWD in PR group was higher than that in control group [(341.55 ±84.40)m vs
(301.72±72.76）m, P＜0.05], while there was no significant difference in FEV1% [(55.72 ±9.28)% vs (53.10 ±8.27)%, P ＞0.05] between two groups. The frequency of acute exacerbation and readmission was less in PR group than those in control group in the follow-up period (P＜0.05). Conclusion The application of pulmonary rehabilitation in patients with AECOPD can shorten the length of hospital stay and decrease medical costs, improve quality of life, physical performance, and the lung function; it also can alleviate inflammation of acute exacerbation and minimize the risk of readmission. |
| Key words: Pulmonary rehabilitation Chronic obstructive pulmonary disease Acute exacerbations Comprehensive evaluation |
