行为转变理论在慢性阻塞性肺疾病患者呼吸训练中的应用

目的探讨基于行为转变理论的呼吸训练干预在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法将72例COPD患者随机分为干预组和对照组各36例。对照组接受常规呼吸训练指导,干预组实施行为转变理论的呼吸训练干预措施。结果干预后干预组肺功能指标显著优于对照组(均P<0.01)。结论以行为转变理论为基础的呼吸训练干预可改善COPD患者肺功能。     

慢性阻塞性肺疾病患者睡眠质量及影响因素调查

目的了解慢性阻塞性肺疾病(COPD)患者睡眠状况及风险因素。方法便利抽取COPD患者和健康体检对照人群各100例为研究对象,采用匹兹堡睡眠质量指数量表(PSQI)、睡眠信念与态度量表(DBAS)、焦虑自评量表(SAS)、呼吸困难量表(MMRC)、圣乔治呼吸问卷(SGRQ)进行调查,采集一般资料、行肺功能等检查。结果 COPD组和对照组睡眠障碍发生率分别为72.92%和42.86%,两组比较,差异有统计学意义(P0.01)。COPD组的PSQI总分及各维度得分显著高于对照组(P0.05,P0.01)。睡眠障碍组患者与无睡眠障碍组患者在年龄、夜间治疗、第1秒用力呼气量占预计值的百分比、呼吸困难分级、SAS评分、SGRQ评分及DBAS评分方面的差异有统计学意义(P0.05,P0.01)。呼吸困难分级、DBAS、SGRQ是影响睡眠质量的主要因素(P0.05,P0.01)。结论 COPD患者睡眠质量较差。呼吸困难程度、睡眠认知、躯体症状、心理状况等是影响睡眠质量的主要因素,积极治疗原发病、改善呼吸功能和躯体症状,建立有效的睡眠认知是提高睡眠质量的关键。     

慢性阻塞性肺疾病病人呼吸训练方法的对比观察

将60例稳定期慢性阻塞性肺疾病（COPD）病人随机分成I组和Ⅱ组,分别进行缩唇腹式呼吸训练和缩唇腹式呼吸加入工阻力呼吸训练,每次3－5min,3-4次／d,训练20d。训练前后两组病人均行肺通气功能检查。结果训练后Ⅱ组肺通气功能各项指标改善较好,与I组比较,差异有显著性意义（P＜0．05）,与本组训练前比较,差异有极显著性意义（P＜0．01）。提示缩唇腹式呼吸配合人工阻力呼吸训练在提高呼吸肌肌力,改善肺功能方面疗效显著,可作为稳定期COPD病人的康复护理手段。     

痰热郁肺型慢性阻塞性肺疾病患者子午流注择时穴位按摩的研究

目的探讨子午流注择时穴位按摩对痰热郁肺型慢性阻塞性肺疾病患者的应用效果。方法将60例痰热郁肺型慢性阻塞性肺疾病急性加重期患者随机分成观察组和对照组各30例。对照组予常规治疗护理及机械辅助排痰,观察组在对照组的基础上应用子午流注择时穴位按摩,疗程均为7d。比较两组干预前后咳嗽、咳痰、喘息、气短4项主证的症状评分和护理总有效率,以及血气指标(PaO_2、PaCO_2、血氧饱和度)的变化。结果观察组干预后4项主证的症状评分显著低于对照组,护理有效率显著高于对照组,PaO_2和PaCO_2改善显著优于对照组(P0.05,P0.01)。结论子午流注择时穴位按摩能有效改善痰热郁肺型慢性阻塞性肺疾病急性加重期患者的主要症状,改善动脉血气指标,提高临床疗效。     

呼吸操联合穴位按摩对老年尘肺病患者肺功能及运动能力的影响

目的 提高老年尘肺病患者肺功能及运动能力.方法 将83例老年尘肺病患者采用随机数字表法分为干预组(n=41)和对照组(n=42).对照组进行常规治疗护理及康复训练,干预组在对照组基础上进行12周的呼吸操联合穴位按摩.两组干预前后测评肺功能指标、6 min步行距离.结果 干预后,干预组6 min步行距离、第1秒用力呼气容...     

稳定期慢性阻塞性肺疾病患者久坐行为现状及影响因素分析

目的 了解稳定期慢性阻塞性肺疾病患者久坐行为现状,并分析其影响因素,为制订针对性干预措施提供参考。方法 便利选取苏州市6所医疗机构门诊就诊的慢性阻塞性肺疾病患者233例,采用一般资料问卷、国际体力活动问卷短卷、久坐行为日志、肺功能状态和呼吸困难问卷修订版、呼吸困难信念问卷、医院焦虑抑郁量表、社会支持评定量表进行调查。结果 稳定期慢性阻塞性肺疾病患者日均久坐行为时间为（7.42±2.40）h,159例（68.24%）患者的久坐行为总时间＞6 h。logistic回归分析显示,是否了解久坐危害、吸氧情况、COPD评估测试量表评分、呼吸困难信念的恐惧活动维度得分是稳定期慢性阻塞性肺疾病患者久坐行为的影响因素（均P<0.05）。结论 稳定期慢性阻塞性肺疾病患者久坐时间较长,久坐行为较为普遍。医护人员需要采取有效干预策略,以提高患者体力活动水平,改善其疾病预后。     

老年慢性阻塞性肺疾病患者衰弱现状及影响因素的Meta分析

目的 系统评价老年慢性阻塞性肺疾病患者衰弱现状及其影响因素。方法 计算机检索各数据库,检索时限为2000年至2022年2月。由2名研究者独立进行文献筛选、质量评价、信息提取,分别采用Stata12.0和RevMan5.3软件进行患病率及影响因素的Meta分析。结果 共纳入26篇文献,6 849例患者。Meta分析结果显示,COPD患者衰弱患病率为34%,其中年龄（OR=1.15）、GOLD分级（OR=3.00）、呼吸困难指数（OR=3.44）、抑郁（OR=3.36）、并存疾病（OR=3.39）、多重用药（OR=4.09）、营养不良（OR=5.79）是衰弱的主要危险因素。结论 老年慢性阻塞性肺疾病患者衰弱发生率高,影响因素较多。应针对衰弱危险因素进行早期筛查、早期干预,以减少不良结局对患者的影响。     

人工气腹治疗慢性阻塞性肺疾病的护理干预

目的探讨人工气腹治疗慢性阻塞性肺疾病(COPD)的临床效果及护理干预方法。方法对50例COPD患者于人工气腹治疗前实施心理干预、戒烟指导、呼吸功能锻炼,治疗中嘱患者勿咳嗽等,治疗后妥善包扎腹部,加强饮食护理和耐寒锻炼等。结果人工气腹治疗6～24个月,COPD患者肺功能指标(FVC、MVV、FEV1%)、6分钟行走距离、呼吸困难分级及健康状况均显著改善,年COPD急性发作次数显著降低(均P0.05),戒烟率为64.29%。结论COPD患者经人工气腹治疗,配合系统的护理,可有效改善患者心肺功能和生活质量。     

Propofol induces bronchodilation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients

The aim of this study was to evaluate the effects of propofol administration (2 mg · kg^-1 i.v.) on the airways resistances and respiratory mechanics of patients affected by COPD exacerbation, requiring mechanical ventilation. Twenty patients required anaesthesia for diagnostic or therapeutic procedures. Fourteen consecutive patients were divided at random into two groups: Group P received propofol and Group C (control) received only Intralipid 10%; an additional group of six patients received i.v. flunitrazepam (0.03 mg · kg^-1). Lung mechanics (dynamic and static compliance, peak inspiratory pressure, intrinsic positive and expiratory pressure, minimal and maximal resistances of the respiratory system) were evaluated in basal conditions and 3 and 6 min after propofol, Intralipid or flunitrazepam administration. We did not observe significant variations of the evaluated variables after Intralipid or flunitrazepam (Groups C and F), while in patients who received propofol (Group P), we observed the following modifications: dynamic compliance increased from 2.3 ± 0.3 to 2.8 ± 0.4 ml · kPa^-1 (P<0.05), peak inspiratory pressure decreased from 3.3 ± 0.7 to 2.8 ± 0.4 kPa (P <0.05), minimal resistances of the respiratory system (that mainly reflect airways resistances) decreased from 1 ± 0.2 to 0.7 ± 0.2 kPa · 1^-1 · s^-1 (P <0.01). Our results suggest that propofol induces bronchodilation in mechanically ventilated COPD patients, and that this effect is not related specifically to the induction of general anesthesia.     

肺功能档案在稳定期COPD患者肺康复治疗中的应用

目的 探讨肺功能档案用于稳定期COPD患者肺康复治疗的效果.方法 将62例稳定期COPD患者随机分成两组各31例.对照组出院后采用常规专科门诊电话随访(每个月1次),要求患者每年复查肺功能;观察组在此基础上出院前建立肺功能档案,提出每年确保FEV1下降≤50 mL的目标,要求患者出院后3、6、12个月分别复查肺功能,根据肺功能档案内容进行动态干预.结果 干预12个月后,观察组肺功能指标及相关健康行为显著优于对照组(P＜0.05,P＜0.01).结论 建立稳定期COPD患者肺功能档案能使患者动态了解肺功能情况,增强患者自我健康管理行为,提高肺康复效果.     

9种运动方式对COPD患者肺康复影响的网状Meta分析

目的 评价不同运动方式对COPD患者肺康复的影响,为患者选择最优运动措施提供参考。方法 计算机检索国内外8个数据库关于运动训练改善COPD患者肺康复效果的随机对照试验。检索时限均从建库至2022年3月1日。由2名评价员独立筛选文献、提取内容。采用R4.1和ADDIS软件进行网状Meta分析。结果 共纳入34项研究,包括2 373例患者,运动方式共9种。网状Meta分析显示：与常规治疗和护理比较,9种运动方式均有效改善COPD患者肺功能（FEV1%pred、FEV1/FVC%）及呼吸困难程度（除瑜伽运动不能改善FEV1%pred外）;FEV1%pred组间比较显示, 抗阻运动、太极拳、有氧抗阻联合运动优于八段锦,太极拳优于呼吸操和六字诀。最优概率结果显示：抗阻训练对肺功能的改善效果最好;六字诀对呼吸困难症状改善效果最好。结论 运动疗法能有效改善COPD患者肺功能和呼吸困难症状,可根据干预预期目标选择合适的运动方式。     

老年慢性阻塞性肺疾病患者的综合家庭肺康复研究

目的 制定适合老年慢性阻塞性肺疾病患者的综合家庭肺康复方案,以提高肺康复效果。方法 将60例病情稳定出院的老年慢性阻塞性肺疾病患者随机分为对照组和干预组各30例。对照组实施常规护理,干预组实施基于证据的综合家庭肺康复方案,干预6个月。采用呼吸困难评分、6 min步行试验、圣乔治呼吸问卷进行效果评价。结果 干预3个月、6个月干预组呼吸困难评分及圣乔治呼吸问卷得分显著低于对照组,6 min步行试验距离显著长于对照组(均P<0.05)。结论 对老年慢性阻塞性肺疾病稳定期患者实施综合家庭肺康复,有助于改善呼吸困难症状、提高机体活动能力、改善生活质量。     

Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease

Objective: The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods: Prospectively, 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (Rehab. Group). The criteria of COPD were preoperative forced expiratory volume in 1 second (FEVl)/forced vital capacity (FVC) ≦70% and more than 50% of low attenuation area in a computed tomography. Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively. As a historical control, 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 (control group) were entered in this study. Results: Patient backgrounds were all equivalent between the two groups. However, FEV1 and FEV1/FVC were significantly lower in the Rehab. Group (p<0.05). Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group. The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab. Group (p=0.047). Furthermore, postoperative hospital stay was significantly longer in the control group (p=0.0003). Conclusion: Despite lower FEV1 and FEV1/FVC in the Rehab. Group, postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy.     

Video-assisted lobectomy for a lung cancer patient with chronic obstructive pulmonary disease

Objectives: This retrospective study was conducted to see whether a video-assisted lobectomy is beneficial in lung cancer patients with chronic obstructive pulmonary disease regarding preservation of pulmonary function compared to lobectomy by standard thoracotomy.Subjects and Methods: Between 1982 and 2002, 67 patients who underwent lobectomy for primary lung cancer showed 55% or less of preoperative forced expiratory, volume in one second/vital capacity. Among them, 25 patients were enrolled in this retrospective study. The remaining 42 patients were excluded because of no presence of a postoperative pulmonary function test. Nine of 25 patients underwent a video-assisted lobectomy between 1994 and 2002 and the remaining 16 patients who underwent a lobectomy by standard thoractomy between 1982 and 1994 were employed as a historical control. Perioperative conditions and changes in pulmonary function were compared between two groups.Results: A parameter of chest wall damage was minor in video-assisted lobectomy compared to that in lobectomy by standard thoracotomy. Changes between pre- and postoperative percent of vital capacity, forced expiratory volume in one second and maximal ventilatory volume showed significantly minor deterioration or even improvement in video-assisted lobectomy patients. Predicted postoperative pulmonary function tended to be underestimated for postoperative values in video-assisted lobectomy patientsConclusions: Video-assisted lobectomy seemed to be profitable in preservation of pulmonary function in lung cancer patients with chronic obstructive pulmonary disease. Prediction of postoperative pulmonary function should be revised due to the underestimation for postoperative values in video-assisted lobectomy, which could offer profitable surgical treatment for lung cancer patients with chronic obstructive pulmonary disease.     

Six-minute walking and pulmonary function test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease

Objective: To evaluate physical dysfunction during the early period after lung resection in patients with lung cancer and coexisting chronic obstructive pulmonary disease (COPD), we examined the relationship between the ratio of the forced expiratory volume in 1 second to the forced vital capacity (FEV₁/FVC%) and the results of a 6-minute walk (6MW) test before and after surgery. Methods: Eighty-three patients who underwent lobectomy for lung cancer were classified into three groups according to their preoperative FEV₁/FVC: more than 70% (non-COPD, n=61), 60–69% (mild COPD, n=15), and 40–59% (moderate COPD, n=7). The 6MW and pulmonary function tests were performed before surgery and repeated 1 and 2 weeks after surgery. During the 6MW test, the distance covered during a 6MW test (6MWD) and the decrease in oxygen saturation (SpO₂) were measured. Results: During both the preoperative and postoperative 6MW tests, the decrease in SpO2 correlated significantly with the preoperative FEV₁/FVC% (p<0.001). The percentage decrease in 6MWD at 1 and 2 weeks after surgery correlated significantly with the preoperative FEV₁/FVC% (p<0.001 and p=0.04, respectively), but not with the concomitant percentage reduction in vital capacity (VC). The differences of the decreases in postoperative 6MWD and SpO₂ during the 6MW test were significant between the moderate and mild COPD patients and between the mild COPD and non-COPD patients (p<0.01–0.001). Conclusion: The decreases in 6MWD and SpO₂ after surgery were significantly influenced by the preoperative FEV₁/FVC%, but not by the decrease in VC. COPD patients have a limited capacity for walking during the early period after surgery due to significant oxygen desaturation.     

阻塞性肺疾病危险因素与术后肺部并发症关系的研究

目的分析围手术期合并慢性阻塞性肺疾病(COPD)者的自身因素、手术因素与手术后肺部并发症(PPC)发生的关系及术前各项肺功能指标和动脉血氧分压(PaO2)与PPC的关系。方法对2002年9月至2004年11月中国医科大学附属第一医院重症医学科收治的54例围手术期COPD病人按年龄、体重指数(BMI)、手术时间及手术部位分别分组,对不同组间PPC的发生率进行χ2检验;利用SPSS11.12统计软件对术前动脉血氧分压(PaO2)和肺功能指标与PPC间的关系、对术前动脉血氧分压(PaO2)和肺功能指标与术后机械通气(MV)时间的关系进行多元相关分析。结果54例病人中30例(55.6%)发生PPC。年龄>70岁组与年龄≤70岁组的PPC发生率差异无显著性意义;BMI≥24组的PPC发生率显著高于BMI<24组;手术时间≥2h组的PPC发生率显著高于<2h组;上腹部手术组PPC的发生率显著高于下腹部组。术前PaO2和各肺功能指标与PPC的发生呈负相关趋势;而肺通气功能的各项指标与术后机械通气(MV)时间也呈负相关趋势。结论围手术期COPD病人,BMI≥24、手术时间≥2h者,上腹部手术者,术前肺通气功能较差者,PPC的发生率高;术前阻塞性肺通气功能障碍越重,MV时间越长。