Ries Andrew L, Make Barry J, Lee Shing M, Krasna Mark J, Bartels Matthew, Crouch Rebecca, Fishman Alfred P
UCSD Medical Center, 200 W Arbor Dr, No. 8377, San Diego, CA 92103-8377, USA.
Chest. 2005 Dec;128(6):3799-809. doi: 10.1378/chest.128.6.3799.
Pulmonary rehabilitation is an established treatment in patients with chronic lung disease but is not widely utilized. Most trials have been conducted in single centers. The National Emphysema Treatment Trial (NETT) provided an opportunity to evaluate pulmonary rehabilitation in a large cohort of patients who were treated in centers throughout the United States.
Prospective observational study of cohort prior to randomization in a multicenter clinical trial.
University-based clinical centers and community-based satellite pulmonary rehabilitation programs.
A total of 1,218 patients with severe emphysema underwent pulmonary rehabilitation before and after randomization to lung volume reduction surgery (LVRS) or continued medical management. Rehabilitation was conducted at 17 NETT centers supplemented by 539 satellite centers.
Lung function, exercise tolerance, dyspnea, and quality of life were evaluated at regular intervals. Significant (p < 0.001) improvements were observed consistently in exercise (cycle ergometry, 3.1 W; 6-min walk test distance, 76 feet), dyspnea (University of California, San Diego Shortness of Breath Questionnaire score, -3.2; Borg breathlessness score: breathing cycle, -0.8; 6-min walk, -0.5) and quality of life (St. George Respiratory Questionnaire score, -3.5; Quality of Well-Being Scale score, +0.035; Medical Outcomes Study 36-item short form score: physical health summary, +1.3; mental health summary, + 2.0). Patients who had not undergone prior rehabilitation improved more than those who had. In multivariate models, only prior rehabilitation status predicted changes after rehabilitation. In 20% of patients, exercise level changed sufficiently after rehabilitation to alter the NETT subgroup predictive of outcome. Overall, changes after rehabilitation did not predict differential mortality or improvement in exercise (primary outcomes) by treatment group.
The NETT experience demonstrates the effectiveness of pulmonary rehabilitation in patients with severe emphysema who were treated in a national cross-section of programs. Pulmonary rehabilitation plays an important role in preparing and selecting patients for surgical interventions such as LVRS.
肺康复是慢性肺病患者的既定治疗方法，但尚未得到广泛应用。大多数试验是在单一中心进行的。国家肺气肿治疗试验（NETT）提供了一个机会，可对在美国各地中心接受治疗的大量患者群体进行肺康复评估。
在一项多中心临床试验中，对随机分组前的队列进行前瞻性观察研究。
以大学为基础的临床中心和以社区为基础的卫星肺康复项目。
共有1218例重度肺气肿患者在随机分组接受肺减容手术（LVRS）或继续药物治疗之前和之后接受了肺康复。康复在17个NETT中心进行，并由539个卫星中心提供补充。
定期评估肺功能、运动耐量、呼吸困难和生活质量。在运动（自行车测力计，3.1瓦；6分钟步行试验距离，76英尺）、呼吸困难（加利福尼亚大学圣地亚哥分校呼吸急促问卷评分，-3.2；博格呼吸困难评分：呼吸周期，-0.8；6分钟步行，-0.5）和生活质量（圣乔治呼吸问卷评分，-3.5；幸福感量表评分，+0.035；医学结局研究36项简表评分：身体健康总结，+1.3；心理健康总结，+2.0）方面均持续观察到显著改善（p<0.001）。未接受过先前康复治疗的患者比接受过的患者改善更大。在多变量模型中，只有先前的康复状态可预测康复后的变化。20%的患者在康复后运动水平发生了足够大的变化，从而改变了NETT中预测结局的亚组。总体而言，康复后的变化并不能预测不同治疗组的死亡率差异或运动改善情况（主要结局）。
NETT的经验证明了肺康复在全国范围内一系列项目中治疗的重度肺气肿患者中的有效性。肺康复在为诸如LVRS等手术干预准备和选择患者方面发挥着重要作用。
