Physiotherapy Department, Maroondah Hospital, Eastern Health, PO Box 135, Ringwood, East Victoria 3135, Australia.
Physiotherapy. 2010 Mar;96(1):1-13. doi: 10.1016/j.physio.2009.06.008. Epub 2009 Sep 22.
To examine the effectiveness of chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD).
CINAHL, MEDLINE, Embase, Cochrane, Expanded Academic Index, Clinical Evidence, PEDro, Pubmed, Web of Knowledge and Proquest were searched from the earliest available time to September 2007, using the key elements of COPD, acute exacerbation and chest physiotherapy interventions.
To be included, trials had to investigate patients during admission to hospital with an acute exacerbation of COPD, and to evaluate at least one physiotherapy intervention. Two reviewers independently applied the inclusion criteria, and assessed trial quality using the PEDro scale. Results were expressed as standardised mean differences and analysed qualitatively with a best-evidence synthesis.
Thirteen trials were identified. There was moderate evidence that intermittent positive pressure ventilation and positive expiratory pressure were effective in improving sputum expectoration. In addition, there was moderate evidence that walking programmes led to benefits in arterial blood gases, lung function, dyspnoea and quality of life. No evidence was found supporting the use of any other chest physiotherapy techniques to change lung function, arterial blood gases, perceived level of dyspnoea or quality of life.
Chest physiotherapy techniques such as intermittent positive pressure ventilation and positive expiratory pressure may benefit patients with COPD requiring assistance with sputum clearance, while walking programmes may have wider benefits for patients admitted with an exacerbation of COPD. Chest physiotherapy techniques other than percussion are safe for administration to this patient population.
研究胸部物理治疗对慢性阻塞性肺疾病（COPD）急性加重期住院患者的疗效。
从最早的可用时间到 2007 年 9 月，使用 COPD、急性加重和胸部物理治疗干预的关键要素，在 CINAHL、MEDLINE、Embase、Cochrane、Expanded Academic Index、Clinical Evidence、PEDro、Pubmed、Web of Knowledge 和 Proquest 上进行了检索。
纳入的试验必须调查急性加重期 COPD 住院患者，并评估至少一种物理治疗干预措施。两位审查员独立应用纳入标准，并使用 PEDro 量表评估试验质量。结果表示为标准化均数差，并采用最佳证据综合法进行定性分析。
确定了 13 项试验。有中等质量证据表明间歇正压通气和呼气正压在促进痰液排出方面有效。此外，有中等质量证据表明步行计划可改善动脉血气、肺功能、呼吸困难和生活质量。没有证据支持使用任何其他胸部物理治疗技术来改变肺功能、动脉血气、呼吸困难的感知程度或生活质量。
胸部物理治疗技术，如间歇正压通气和呼气正压，可能对需要排痰的 COPD 患者有益，而步行计划可能对因 COPD 加重而住院的患者有更广泛的益处。除叩击外，其他胸部物理治疗技术对该患者群体是安全的。
