Clini Enrico M, Crisafulli Ernesto, Costi Stefania, Rossi Giuseppina, Lorenzi Cristina, Fabbri Leonardo M, Ambrosino Nicolino
Department Oncology, Haematology and Pneumology, University of Modena, Modena, Italy.
Respir Med. 2009 Oct;103(10):1526-31. doi: 10.1016/j.rmed.2009.04.011. Epub 2009 May 15.
We have undertaken an observational retrospective cohort study to assess feasibility and clinical effectiveness of early rehabilitation in patients recovering from acute exacerbation of COPD (AECOPD). A cohort of 1826 inpatients (73% male, age 70+/-8 yrs, FEV(1) 50+/-16% pred.) admitted to a pulmonary rehabilitation (PR) program and completing at least 15 sessions were divided into categories according to their dyspnoea grade (Medical Research Council--MRC scores 2-5) as assessed before AECOPD. The pre-post changes in 6-minute walking distance (6MWD) test, perceived end-effort dyspnoea (Borg scale), and self-reported quality of life (St. George's respiratory Questionnaire: SGRQ) were measured throughout. Absolute change in 6MWD (52 [95%CI 45-59], 65 [95%CI 60-70], 63 [95%CI 59-66], and 70 [95%CI 67-74] meters in MRC 2-5 respectively) and the percentage of patients achieving the minimal clinically important difference (MCID) of +54 m (40, 55, 57, and 61%, respectively, p=0.001) differed across MRC grades. Proportion of patients able to reach > or = 350 m at the 6MWD after PR was higher in MRC 4 and 5 (18 and 22%) as compared to MRC 2 and 3 (6 and 15%). Early PR in a cohort of AECOPD patients is feasible and it is associated to clinically meaningful improvement in exercise tolerance independent on the severity of dyspnoea. The proportion of patients reaching the limit of > or = 350 m after this intervention is higher in the most severe patients.
我们开展了一项观察性回顾性队列研究，以评估慢性阻塞性肺疾病急性加重（AECOPD）康复期患者早期康复的可行性和临床效果。1826名住院患者（73%为男性，年龄70±8岁，第一秒用力呼气容积[FEV(1)]为预计值的50±16%）参加了肺康复（PR）项目并完成了至少15次治疗，根据AECOPD发作前评估的呼吸困难分级（医学研究委员会——MRC评分2 - 5级）进行分类。在整个过程中测量了6分钟步行距离（6MWD）测试、主观用力性呼吸困难（Borg量表）和自我报告的生活质量（圣乔治呼吸问卷：SGRQ）的前后变化。6MWD的绝对变化（MRC 2 - 5级分别为52[95%CI 45 - 59]、65[95%CI 60 - 70]、63[95%CI 59 - 66]和70[95%CI 67 - 74]米）以及达到最小临床重要差异（MCID）+54米的患者百分比（分别为40%、55%、57%和61%，p = 0.001）在不同MRC分级中有所不同。与MRC 2和3级（6%和15%）相比，PR后6MWD能够达到≥350米的患者比例在MRC 4和5级中更高（分别为18%和22%）。AECOPD患者队列中的早期PR是可行的，并且与运动耐力的临床意义改善相关，与呼吸困难的严重程度无关。在最严重的患者中，这种干预后达到≥350米限制的患者比例更高。
