Dept of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
Respir Med. 2009 Jul;103(7):1070-5. doi: 10.1016/j.rmed.2009.01.009. Epub 2009 Feb 13.
It is not clear whether the benefits of pulmonary rehabilitation (PR) apply equally to patients with Chronic Obstructive Pulmonary Disease (COPD) with different levels of starting disability. We have therefore investigated the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in patients with COPD.
This is a retrospective, observational study of data collected from 450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age 69.5 (8.9) yrs and FEV(1) 44.6 (19.7)% predicted. The Incremental Shuttle Walk Test (ISWT) was performed before and after the seven-week course
395 patients (88%) completed the programme. The mean (SD) baseline ISWT performance was 167 (113)m. The distribution of baseline MRC grades was 2 - 15.4%, 3 - 24.9%, 4 - 27.3% and 5 - 32.4%. The mean (95% CI) improvement in ISWT after PR for each MRC scale grade was highly significant (p<0.0005); 2 - 66 (50-83)m, 3 - 63 (50-75)m, 4 - 59 (49-70)m, and 5 - 54 (43-64)m.
Patients with COPD, of all MRC dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both statistically and clinically meaningful improvements in exercise performance. MRC grade should therefore not be used to exclude patients from pulmonary rehabilitation.
目前尚不清楚肺康复（PR）的益处是否同样适用于起始残疾程度不同的慢性阻塞性肺疾病（COPD）患者。因此，我们研究了 MRC 呼吸困难量表分层的 COPD 患者肺康复的效果。
这是一项回顾性、观察性研究，对 450 名连续接受门诊 PR 的 COPD 患者的数据进行了分析：247 名男性，平均（SD）年龄 69.5（8.9）岁，FEV1 为预计值的 44.6（19.7）%。在为期 7 周的疗程前后进行了递增式穿梭步行试验（ISWT）。
395 名患者（88%）完成了该方案。ISWT 基线表现的平均（SD）为 167（113）m。基线 MRC 分级的分布为 2 - 15.4%、3 - 24.9%、4 - 27.3%和 5 - 32.4%。PR 后 ISWT 的平均（95%CI）改善在每个 MRC 量表等级上均具有高度显著性（p<0.0005）；2 - 66（50-83）m、3 - 63（50-75）m、4 - 59（49-70）m 和 5 - 54（43-64）m。
所有 MRC 呼吸困难分级的 COPD 患者均能从肺康复中获益，在运动表现方面均取得了统计学和临床意义上的显著改善。因此，MRC 分级不应作为将患者排除在肺康复之外的依据。
