Baltzan Marcel A, Kamel Hany, Alter Arlene, Rotaple Michael, Wolkove Norman
Department of Medicine, Mount Sinai Hospital Center, Montreal, Quebec.
Can Respir J. 2004 Sep;11(6):407-13. doi: 10.1155/2004/632153.
There is limited evidence that pulmonary rehabilitation improves exercise capacity in older patients with chronic respiratory disease. The objective of the present study was to determine whether patients 80 years of age or older gain similar benefits from pulmonary rehabilitation as do younger patients.
Outcomes were compared in 230 consecutive inpatients with moderate to severe lung disease who participated in a comprehensive pulmonary rehabilitation program during a one-year period. Outcomes included 6 min walk test distance (6MWT), the number of stairs completed in 2 min (2MST), Borg dyspnea scores after exertion and objective functional scores.
There were no differences between older (80 to 91 years, n=43) and younger patients (n=187) with respect to sex, forced expiratory volume in 1 s (mean 0.77 L versus 0.72 L) or number of chronic medical diagnoses (2.4 versus 2.7). Older patients were less frequently survivors of mechanical ventilation (2.3% versus 16%). Baseline 6MWT (133 m versus 144 m; P=0.48) and 2MST (5.2 laps versus 6.5 laps; P=0.067) were similar but global function was lower (85 versus 89; P=0.040) in older patients than in younger patients, respectively. After pulmonary rehabilitation, all outcomes improved significantly regardless of age (all before-after comparisons P<0.0001). Younger patients improved with a higher discharge 6MWT (231 m versus 185 m; P=0.004) and similar discharge 2MST (9.3 laps versus 7.9 laps; P=0.070) compared with older patients. Global function at discharge remained lower in older patients than younger patients (91 versus 94; P=0.002). The duration of rehabilitation and length of stay were similar between the two groups.
A comprehensive inpatient pulmonary rehabilitation program is beneficial in selected patients 80 years of age or older.
关于肺康复改善老年慢性呼吸道疾病患者运动能力的证据有限。本研究的目的是确定80岁及以上患者从肺康复中获得的益处是否与年轻患者相似。
对230例连续住院的中重度肺部疾病患者进行了为期一年的综合肺康复计划，并比较了其结果。结果包括6分钟步行试验距离（6MWT）、2分钟内完成的楼梯步数（2MST）、运动后Borg呼吸困难评分和客观功能评分。
老年患者（80至91岁，n = 43）与年轻患者（n = 187）在性别、第1秒用力呼气量（平均0.77 L对0.72 L）或慢性疾病诊断数量（2.4对2.7）方面无差异。老年患者机械通气存活者较少（2.3%对16%）。老年患者的基线6MWT（133 m对144 m；P = 0.48）和2MST（5.2圈对6.5圈；P = 0.067）相似，但总体功能低于年轻患者（85对89；P = 0.040）。肺康复后，无论年龄大小，所有结果均有显著改善（所有前后比较P < 0.0001）。与老年患者相比，年轻患者出院时6MWT改善更高（231 m对185 m；P = 0.004），出院时2MST相似（9.3圈对7.9圈；P = 0.070）。老年患者出院时的总体功能仍低于年轻患者（91对94；P = 0.002）。两组的康复持续时间和住院时间相似。
综合性住院肺康复计划对80岁及以上选定患者有益。
