| 田蕾,郭羽,陈海军.渐进抗阻吸气肌训练对脑卒中伴慢性阻塞性肺疾病患者呼吸力学、肺功能及mMRC分级的影响[J].中国康复,2021,36(12):729-733 |
| 渐进抗阻吸气肌训练对脑卒中伴慢性阻塞性肺疾病患者呼吸力学、肺功能及mMRC分级的影响 |
| Effect of progressive resistance inspiratory muscle training on respiratory mechanics, pulmonary function and mMRC grading in stroke patients with COPD |
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| DOI： |
| 中文关键词: 渐进抗阻吸气肌训练 脑卒中 慢性阻塞性肺疾病 肺功能 膈肌功能 |
| 英文关键词: progressive resistance inspiratory muscle training stroke chronic obstructive pulmonary diseases pulmonary function diaphragm function |
| 基金项目:上海市第二康复医院院内科研项目（Y2020-25） |
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| 中文摘要: |
| 目的：探讨渐进抗阻吸气肌训练对脑卒中伴慢性阻塞性肺疾病患者呼吸力学、肺功能及呼吸困难（mMRC）分级的影响。方法：114例脑卒中伴慢性阻塞性肺疾病患者，随机分为观察组和对照组各57例。对照组采取常规呼吸训练，观察组在此基础上采取渐进抗阻吸气肌训练，持续6周。统计2组患者急性加重次数、住院次数及治疗前后呼吸力学指标［响应频率（Fres）、5Hz振荡频率下的气道阻力（R5）、肺顺应性（Cl）、气道阻力（Raw）］、肺功能［第1 s用力呼气容积占预计值百分比（FEV1%）、第1 s用力呼气容积/用力肺活量（FEV1/FVC）、用力肺活量（FVC）］、6 min步行距离（6MWD）、膈肌功能［吸气末膈肌厚度（DTei）、呼气末膈肌厚度（DTee）、膈肌移动度］及采用改良版英国医学研究委员会呼吸问卷（mMRC）、慢性阻塞性肺疾病自我评估测试（CAT）、圣乔治呼吸问卷（SGRQ）对患者进行评定。结果：观察组急性加重次数及住院次数均少于对照组（均P＜0.01）；治疗6周后，观察组Fres、R5、Raw均低于对照组，Cl高于对照组（均P＜0.05），观察组FEV1/FVC、FVC、FEV1%及6MWD均高于对照组（均P＜0.05），观察组膈肌移动度、DTei均大于对照组（均P＜0.05），观察组mMRC、CAT、SGRQ评分低于对照组（均P＜0.05），且观察组较对照组同时间点比较，除了DTee其余指标均有统计学意义。结论：渐进抗阻吸气肌训练能改善脑卒中伴慢性阻塞性肺疾病患者呼吸力学，恢复膈肌功能和肺功能，在缓解患者呼吸困难、减轻病情程度、提高生活质量方面具有重要作用。 |
| 英文摘要: |
| Objective: To explore the effect of progressive resistance inspiratory muscle training on respiratory mechanics, pulmonary function and dyspnea (mMRC) classification in stroke patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 114 stroke patients with COPD were randomly divided into treatment group and control group with 57 cases each. The control group was given regular breathing training, and the treatment group was subjected to progressive resistance inspiratory muscle training based on the control group for a total of 6 weeks. The number of acute exacerbations, the number of hospitalizations and the respiratory mechanics indexes ［resonance frequency (Fres), respiratory resistance at 5 Hz (R5), compliance (Cl), airway resistance (Raw)］, pulmonary function ［forced expiratory vohime in the first second (FEV1%), forced expiratory volume in the first s/forced vital capacity (FEV1/FVC), forced vital capacity (FVC)］, 6-min walking distance (6MWD), diaphragm function ［diaphragmatic thickness at the end of inspiration (DTei), diaphragmatic thickness at the end of expiration (DTee), diaphragm movement］, mMRC grade, severity of illness (CAT), quality of life (SGRQ) before and after treatment were measured. Results: The number of acute exacerbations and hospitalizations in the treatment group were less than those in the control group (both P<0.05). After 6 weeks of treatment, the Fres, R5 and Raw in the treatment group were lower than those of the control group, and Cl was higher than the control group (all P<0.05). The FEV1/FVC, FVC, FEV1% and 6MWD in the treatment group were higher than those in the control group (all P＜0.05), the diaphragmatic mobility and DTei of the treatment group were greater than those of the control group (both P<0.05). The scores of mMRC, CAT and SGRQ of the treatment group were lower than those of the control group (all P＜0.05), and the comparison between the treatment group and the control group at the same time point, except for DTee, revealed all other indicators were statistically significant. Conclusion: Progressive resistance inspiratory muscle training can improve the respiratory mechanics of stroke patients with COPD, restore diaphragm function and pulmonary function, and play an important role in relieving breathing difficulties, reducing the severity of the disease, and improving the quality of life. |
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