Inagaki Takeshi, Terada Jiro, Tanabe Nobuhiro, Kawata Naoko, Kasai Hajime, Sugiura Toshihiko, Shigeta Ayako, Asano Yumi, Murata Atsushi, Tsushima Kenji, Tada Yuji, Sakao Seiichiro, Tatsumi Koichiro
Department of Respirology, Graduate School of Medicine, Chiba University, Japan; Division of Rehabilitation, Chiba University Hospital, Japan.
Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
Respir Investig. 2014 Nov;52(6):357-64. doi: 10.1016/j.resinv.2014.07.002. Epub 2014 Sep 4.
Management of chronic thromboembolic pulmonary hypertension (CTEPH) has recently improved because of advances in pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and disease-targeted medications. However, patients with inoperable CTEPH or persistent pulmonary hypertension (PH) after these interventions continue to exhibit impaired exercise capacity and limited quality of life (QOL).
Eight patients with inoperable or residual CTEPH (mean age, 64±12 years; WHO functional class II/III, 6/2; mean pulmonary artery pressure, 47±13 mmHg) in stable condition and receiving disease-targeted medications participated in a 12-week home-based pulmonary rehabilitation program (muscle strength training, respiratory exercises, and walking) with supervised hospital sessions from March 2012 to January 2014. Efficacy parameters were prospectively evaluated at baseline and at completion of the 12-week program.
After completion of the pulmonary rehabilitation program, the 6-minute walking distance (6MWD) (33.3±25.1 m), St. George׳s Respiratory Questionnaire activity score, quadriceps force, and 7-day physical activity level were significantly improved compared with baseline. All subjects completed the rehabilitation program. Although one patient experienced presyncope during the in-hospital exercise sessions, no other severe adverse events or complications of pulmonary rehabilitation were observed.
These findings suggest that home-based pulmonary rehabilitation with closely supervised sessions may safely improve exercise capacity, leg muscle strength, general activity in daily life and health-related QOL in CTEPH patients.
由于肺动脉内膜剥脱术（PEA）、球囊肺动脉成形术（BPA）和疾病靶向药物的进展，慢性血栓栓塞性肺动脉高压（CTEPH）的管理最近有所改善。然而，这些干预后无法手术的CTEPH患者或持续性肺动脉高压（PH）患者的运动能力仍然受损，生活质量（QOL）有限。
2012年3月至2014年1月，8例病情稳定且正在接受疾病靶向药物治疗的无法手术或残留CTEPH患者（平均年龄64±12岁；世界卫生组织功能分级II/III级，6/2；平均肺动脉压47±13 mmHg）参加了一项为期12周的居家肺康复计划（肌肉力量训练、呼吸锻炼和步行），期间有医院监督环节。在基线和12周计划完成时对疗效参数进行前瞻性评估。
肺康复计划完成后，与基线相比，6分钟步行距离（6MWD）（33.3±25.1 m）、圣乔治呼吸问卷活动评分、股四头肌力量和7天身体活动水平均有显著改善。所有受试者均完成了康复计划。虽然1例患者在院内运动期间出现前驱晕厥，但未观察到其他严重不良事件或肺康复并发症。
这些发现表明，在密切监督下的居家肺康复可能会安全地改善CTEPH患者的运动能力、腿部肌肉力量、日常生活中的一般活动以及与健康相关的生活质量。
