居家呼吸康复对中度慢性阻塞性肺疾病患者的作用研究

关键词：慢性阻塞性肺疾病  居家呼吸康复  可穿戴设备  运动心肺测试  门诊呼吸康复

Keywords:chronic obstructive pulmonary disease  home-based pulmonary rehabilitation  wearable devices  cardiopulmonary exercise testing  outpatient pulmonary rehabilitation

摘要：

      摘要 目的：探讨可穿戴式生理监测设备监督下的居家呼吸康复对中度慢性阻塞性肺疾病（简称慢阻肺）的作用。 方法：选取2020年1月—2021年10月首都医科大学附属北京康复医院呼吸康复中心门诊就诊的稳定期中度慢阻肺患者70例，随机分为对照组和试验组，各35例。对照组实施门诊呼吸康复，试验组实施居家呼吸康复，干预时间为10周。试验完成后比较两组依从性。比较两组康复前后7天内心肺运动测试（FEV1、FEV1／FVC%、FEV1%pred、VO2max、VO2AT、最大功率）、慢阻肺评估测试（CAT）、圣乔治呼吸问卷（SGRQ）和改良英国医学研究委员会呼吸困难量表（mMRC）。 结果：70例受试者共脱落15例，最终对照组纳入27例，试验组28例。两组患者康复后FEV1、FEV1／FVC%、FEV1%pred均无显著改善（P＞0.05）；对照组与试验组康复后VO2max、VO2AT、最大功率、SGRQ、CAT和mMRC（18.4±1.6与17.7±1.9、11.9±1.6与11.9±1.4、88.3±8.4与86.4±9.7、35.4±7.5与36.3±8.4、12.8±3.5与13.3±3.7、1.5±0.6与1.8±0.7），相较于康复前（14.2±2.2与13.9±2.4、10.6±1.3与10.3±1.3、69.9±7.5与68.6±9.0、45.4±9.9与45.3±12.1、19.2±3.4与19.5±3.7、2.5±0.9与2.6±1.0）均显著改善（P＜0.01），但组间无显著差异（P＞0.05）；对照组停止训练率显著高于试验组（37%与11%）（P＜0.05），两组未达目标时间和目标强度人数占比[（15%与21%）和（15%与29%）]无显著差异（P＞0.05）。 结论：居家呼吸康复在改善运动功能、症状及生存质量方面与门诊呼吸康复无显著差异，但依从性更佳。

Abstract:

      Abstract Objective: To explore the effect of supervised home-based pulmonary rehabilitation by wearable devices on moderate chronic obstructive pulmonary disease (COPD). Method: A total of 70 patients with moderate COPD in the stable stage who visited the Respiratory Rehabilitation Center of Beijing Rehabilitation Hospital of Capital Medical University from January 2020 to October 2021 were randomly divided into a control group and a study group, with 35 cases in each group. The intervention lasted for 10 weeks. Cardiopulmonary exercise tests (FEV1, FEV1/FVC%, FEV1% pred, VO2max, VO2AT, maximum power), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ) and modified Medical Research Council dyspnea scale (mMRC) were compared between the two groups before and after rehabilitation. After the study was completed, the compliance of the two groups was compared. Result: A total of 15 subjects dropped out of 70 cases, and finally 27 cases were included in the control group and 28 cases in the study group. There was no significant improvement in FEV1, FEV1/FVC%, and FEV1% pred after rehabilitation in the two groups (P>0.05). After rehabilitation, VO2max, VO2AT, maximum power, SGRQ, CAT and mMRC [(14.2±2.2vs.18.4±1.6) and (13.9±2.4vs.17.7±1.9), (10.6±1.3vs.11.9±1.6) and (10.3±1.3vs.11.9±1.4), (69.9±7.5vs.88.3±8.4) and (68.6±9.0vs.86.4±9.7), (45.4±9.9vs.35.4±7.5) and (45.3±12.1vs.36.3±8.4), (19.2±3.4vs.12.8±3.5) and (19.5±3.7vs.13.3±3.7), (2.5±0.9vs.1.5±0.6) and (2.6±1.0vs.1.8±0.7)] were significantly improved (P<0.01), but there were no significant differences between the groups (P>0.05). The stop training rate of the control group was significantly higher than that of the study group (37% vs. 11%, P<0.05). However, there was no significant difference between the two groups in the proportion of people who did not reach the target time and target intensity [(15%vs.21%) and (15%vs.29%)]（P>0.05）. Conclusion: There is no significant difference between home-based pulmonary rehabilitation and traditional outpatient pulmonary rehabilitation in improving exercise capacity, symptoms and quality of life, but the compliance is better.