Lizak Maria Karolina, Singh Sally, Lubina Szymon, Zembala Marian
Silesian Centre for Heart Disease, Zabrze, Poland.
Pol Arch Med Wewn. 2008 Jul-Aug;118(7-8):413-8.
Pulmonary rehabilitation (PR) is an established component of COPD management. The lack of exercise performance improvement (EPI) in severely dyspnoeic patients (Medical Research Council [MRC] score 5) has been questioned. The data on the gender impact on EPI after PR remain scarce.
The impact of dyspnea severity on PR outcomes was investigated and a question was raised whether severe dyspnea at training onset limits the profit from PR in COPD patients. Additionally, the impact of gender on PR results was analyzed.
263 consecutive COPD patients underwent outpatient PR. Exercise capacity was assessed by the incremental shuttle walking test (SWT) and dyspnea with the MRC dyspnea score at inclusion (preSWT, preMRC) and at the end of PR (postSWT, postMRC). The data were analyzed in groups according to preMRC. The grade of improvement (deltaSWT, deltaSWT% and deltaMRC) was compared between groups. The influence of gender was analyzed in 138 men and 125 women.
A significant absolute increase in SWT and a decrease in MRC score were shown in all groups and for both sexes (p < 0.05) with no significant intergroup differences (p > 0.05). deltaSWT% rose significantly with preMRC score and exceeded the values of a clinically important increase (exception: group 2 with preMRC score 2). No significant differences between men and women were observed (deltaMRC: -0.6 vs. -0.7, deltaSWT: 66.7 vs. 56.0 m, deltaSWT%: 63.7 vs. 58.1%, p > 0.05, respectively).
Patients with severe dyspnea did not benefit less from PR. Gender did not influence PR outcome in this study.
肺康复（PR）是慢性阻塞性肺疾病（COPD）管理的既定组成部分。严重呼吸困难患者（医学研究委员会[MRC]评分5分）缺乏运动表现改善（EPI）这一情况受到了质疑。关于性别对PR后EPI影响的数据仍然很少。
研究呼吸困难严重程度对PR结果的影响，并提出一个问题，即训练开始时的严重呼吸困难是否会限制COPD患者从PR中获得的益处。此外，分析了性别对PR结果的影响。
263例连续的COPD患者接受了门诊PR。通过递增往返步行试验（SWT）评估运动能力，并在纳入时（preSWT，preMRC）和PR结束时（postSWT，postMRC）用MRC呼吸困难评分评估呼吸困难情况。根据preMRC将数据分组进行分析。比较各组之间的改善程度（deltaSWT、deltaSWT%和deltaMRC）。对138名男性和125名女性分析了性别的影响。
所有组和男女两性的SWT均有显著的绝对增加，MRC评分均有下降（p<0.05），组间无显著差异（p>0.05）。deltaSWT%随preMRC评分显著升高，且超过了具有临床意义的增加值（例外：preMRC评分为2分的第2组）。未观察到男性和女性之间存在显著差异（deltaMRC：-0.6对-0.7，deltaSWT：66.7对56.0米，deltaSWT%：63.7对58.1%，p均>0.05）。
严重呼吸困难的患者从PR中获得的益处并不更少。在本研究中，性别并未影响PR结果。
