不同運動策略對穩定期慢性阻塞性肺疾病患者的影響_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 李紅 , 劉燕 , 唐健濱 , 張換春 , 李麗華

河北醫科大學附屬華北石油管理局總醫院呼吸內科（河北任丘 062552）;

Corresponding?author：

李紅, Email: 77060229@qq.com

Keywords：

慢性阻塞性肺疾病; 康復訓練; 運動策略

DOI：

10.7507/1671-6205.201803008

Video：

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目的比較不同運動策略對慢性阻塞性肺疾病（簡稱慢阻肺）患者的康復訓練效果。方法收集 2016 年 1 月至 2017 年 1 月在華北石油管理局總醫院呼吸內科門診隨訪的慢阻肺患者 86 例，隨機分為策略一組與策略二組，每組 43 例。在常規藥物治療及健康教育基礎上，策略一組采用功率自行車訓練，策略二組采用地面行走訓練。在訓練進行至 12 周及 24 周時分別比較兩組訓練前后第 1 秒用力呼氣容積占預計值百分比（FEV₁%pred）、第 1 秒用力呼吸容積占用力肺活量百分比（FEV₁/FVC）、最大攝氧量（VO₂max）、6 分鐘步行距離（6MWD）、BODE 指數、慢性阻塞性肺疾病評估測試（CAT）評分、改良英國醫學研究委員會呼吸困難量表、Borg 呼吸困難評分是否有差異，并進行兩組間比較。結果在訓練進行至 12 周時策略一組、策略二組患者訓練后各組指標均有改善，其中除肺功能指標外差異均有統計學意義（均 P<0.05）。同時兩組患者康復運動后指標進行比較，策略一組各組數據均數較策略二組有好轉，其中 VO₂max、6MWD、BODE 指數差異有統計學意義（均 P<0.05）。在訓練進行至 24 周時策略一組、策略二組患者較 12 周時各組指標均有改善，其中 6MWD、BODE 指數、Borg 評分、CAT 評分結果差異有統計學意義（均P<0.05）。同時兩組患者康復運動后指標進行比較，策略一組各組數據均數較策略二組有好轉趨勢，但差異均無統計學意義（均P>0.05）。結論在慢阻肺患者康復訓練中，功率自行車訓練在短期內具有一定的優勢，但堅持訓練后兩種訓練方式基本無明顯差異。

Citation： 李紅, 劉燕, 唐健濱, 張換春, 李麗華. 不同運動策略對穩定期慢性阻塞性肺疾病患者的影響. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 407-410. doi: 10.7507/1671-6205.201803008 Copy

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2.	Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Rrespir Crit Care Med, 2013, 187(4): 347-365.
3.	Mahais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med, 2008, 149(12): 869-878.
4.	吳學敏, 侯來永, 白偉, 等. 呼吸訓練對緩解期老年重度 COPD 患者生存質量及日常生活活動的影響. 中國康復醫學雜志, 2006, 21(4): 307-310.
5.	Spruit MA, Sinqh SJ, Garvey C, et al. An Official American Thoracic Society /European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6.	Moy ML, Martinez CH, Kadri R, et al. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res, 2016, 18(8): e215.
7.	Heerema-Poelman A, Stuive I, Wempe JB. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?. J Cardiopulm Rehabil Prev, 2013, 33(6): 419-426.
8.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南 (2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
9.	Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med, 1998, 158 (5 Pt 1): 1384-1387.
10.	柴晶晶, 柳濤, 蔡柏薔. 慢性阻塞性肺疾病評估測試中文版臨床應用意義的評價. 中華結核和呼吸雜志, 2011, 34(4): 256-258.
11.	Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD, 2012, 9(1): 12-15.
12.	Medinas-Amorós M, Alorda C, Renom F, et al. Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index. Chron Respir Dis, 2008, 5(1): 7-11.
13.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南. 中華結核和呼吸雜志, 2007, 30(1): 8-17.
14.	文紅, 高怡, 安嘉穎, 等. 無氧閾和高強度運動康復對慢性阻塞性肺疾病患者生活質量的影響. 中國呼吸與危重監護雜志, 2009, 8(6): 519-523.
15.	Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet, 1996, 348(9035): 1115-1119.
16.	Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med, 2011, 155(3): 179-191.
17.	Casaburi R. Skeletal muscle function in COPD. Chest, 2000, 117(5Suppl 1): 267S-271S.
18.	DeLisa JA. 呼吸功能障礙患者的康復. 見: 南登昆, 郭正成, 主譯. 康復醫學——理論與實踐. 第 3 版. 西安: 世界圖書出版社, 2004, 624-1228.
19.	Alekseev AE, Guzun R, Reyes S, et al. Restrictions in ATP diffusion within sarcomeres can provoke ATP-depleted zones impairing exercise capacity in chronic obstructive pulmonary disease. Biochim Biophys Acta, 2016, 1860(10): 2269-2278.
20.	Maltais F, LeBlanc P, Simard C, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 442-447.

1. 李群, 陳鋒, 王曉霞, 等. 肺康復訓練對不同嚴重度穩定期慢性阻塞性肺疾病的影響. 中國呼吸與危重監護雜志, 2014, 13(2): 130-135.
2. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Rrespir Crit Care Med, 2013, 187(4): 347-365.
3. Mahais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med, 2008, 149(12): 869-878.
4. 吳學敏, 侯來永, 白偉, 等. 呼吸訓練對緩解期老年重度 COPD 患者生存質量及日常生活活動的影響. 中國康復醫學雜志, 2006, 21(4): 307-310.
5. Spruit MA, Sinqh SJ, Garvey C, et al. An Official American Thoracic Society /European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6. Moy ML, Martinez CH, Kadri R, et al. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res, 2016, 18(8): e215.
7. Heerema-Poelman A, Stuive I, Wempe JB. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?. J Cardiopulm Rehabil Prev, 2013, 33(6): 419-426.
8. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南 (2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
9. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med, 1998, 158 (5 Pt 1): 1384-1387.
10. 柴晶晶, 柳濤, 蔡柏薔. 慢性阻塞性肺疾病評估測試中文版臨床應用意義的評價. 中華結核和呼吸雜志, 2011, 34(4): 256-258.
11. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD, 2012, 9(1): 12-15.
12. Medinas-Amorós M, Alorda C, Renom F, et al. Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index. Chron Respir Dis, 2008, 5(1): 7-11.
13. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南. 中華結核和呼吸雜志, 2007, 30(1): 8-17.
14. 文紅, 高怡, 安嘉穎, 等. 無氧閾和高強度運動康復對慢性阻塞性肺疾病患者生活質量的影響. 中國呼吸與危重監護雜志, 2009, 8(6): 519-523.
15. Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet, 1996, 348(9035): 1115-1119.
16. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med, 2011, 155(3): 179-191.
17. Casaburi R. Skeletal muscle function in COPD. Chest, 2000, 117(5Suppl 1): 267S-271S.
18. DeLisa JA. 呼吸功能障礙患者的康復. 見: 南登昆, 郭正成, 主譯. 康復醫學——理論與實踐. 第 3 版. 西安: 世界圖書出版社, 2004, 624-1228.
19. Alekseev AE, Guzun R, Reyes S, et al. Restrictions in ATP diffusion within sarcomeres can provoke ATP-depleted zones impairing exercise capacity in chronic obstructive pulmonary disease. Biochim Biophys Acta, 2016, 1860(10): 2269-2278.
20. Maltais F, LeBlanc P, Simard C, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 442-447.

Chinese Journal of Respiratory and Critical Care Medicine

不同運動策略對穩定期慢性阻塞性肺疾病患者的影響

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