老年慢性阻塞性肺疾病急性加重住院患者开展早期肺康复干预的效果研究

目的　探讨老年慢性阻塞性肺疾病急性加重（AECOPD）住院患者早期开始肺康复干预的临床疗效。方法　选取2015年3月—2017年3月在上海市第五康复医院老年医学科住院的AECOPD患者120例为研究对象。采用随机数字表法将患者分为对照组和干预组，每组各60例。两组均给予抗炎、祛痰、平喘、氧疗等常规治疗，并发放AECOPD肺康复宣传资料。肺康复干预组于入院第1周内开始肺康复，包括健康教育、放松训练、呼吸训练、运动训练、超短波治疗。分别于住院时及出院6个月后测量肺功能、改良呼吸困难指数（mMRC）分级、慢性阻塞性肺疾病评估测试（CAT）、改良Borg评分、6 min步行距离（6MWD）。结果　对照组、干预组分别有53、43例患者完成随访。对照组6个月后用力肺活量（FVC）、第1秒用力呼气末容积（FEV1）、FEV1占预计值百分比（FEV1%）较住院时下降（P<0.05）；干预组6个月后FVC较住院时下降（P<0.05）；6个月后FEV1、FEV1%与住院时比较，差异均无统计学意义（P>0.05）。对照组6个月后mMRC分级较住院时恶化（P<0.05）；而干预组6个月后mMRC分级与住院时比较，差异无统计学意义（P>0.05）。6个月后，干预组CAT评分、改良Borg评分低于对照组，6MWD大于对照组（P<0.05）。结论　在老年AECOPD住院患者中开展早期肺康复干预能减轻患者症状、改善生活质量、提高活动耐量。

Early Pulmonary Rehabilitation for Elderly Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective　To investigate the clinical efficacy of early pulmonary rehabilitation for hospitalized elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）．Methods　We enrolled 120 elderly inpatients with AECOPD from Department of Geriatrics，the Fifth Rehabilitation Hospital of Shanghai from March 2015 to March 2017 and equally divided them into the control group （n=60） and intervention group （n=60） based on the random number table.Both groups received the conventional treatment including anti-inflammatory therapy，expectorant therapy，anti-asthmatic therapy，oxygen therapy and publicity materials about AECOPD rehabilitation.The intervention group additionally received interventions such as health education，relaxation training，respiratory training，exercise training，and ultrashort wave therapy which started within one week after admission.The pulmonary function，mMRC score，COPD Assessment Test（CAT） score，modified Borg score，and 6MWD were measured on the admission，and 6 months after discharge.Results　Fifty-three in the control group and 43 in the intervention group who completed the follow-up were included in the final analysis.At 6 months after discharge，FVC，FEV1 and FEV1% decreased significantly in the control group compared with on admission（P<0.05），FVC declined significantly（P<0.05） but FEV1 and FEV1% showed little changes in the intervention group compared with on admission（P>0.05）；mMRC score increased significantly in the control group（P<0.05），but changed a little in the intervention group（P>0.05） compared with on admission；CAT score and modified Borg score were much lower while 6MWD was greater in the intervention group compared with the control group（P<0.05）．Conclusion　Early pulmonary rehabilitation can relieve symptoms，improve quality of life and increase exercise tolerance in elderly patients with AECOPD.