Candemir İpek, Ergün Pınar, Kaymaz Dicle, Demir Neşe, Taşdemir Cennet Filiz, Egesel Nurcan, Şengül Fatma
Clinic of Pulmonary Rehabilitation and Home Care Unit, Atatürk Chest Diseases and Chest Surgery Hospital, Ankara, Turkey.
Tuberk Toraks. 2015 Sep;63(3):178-84. doi: 10.5578/tt.9771.
COPD is among the most common causes for secondary pulmonary hypertension (PH). Pulmonary rehabilitation (PR) is recommended in the standard treatment of COPD. In this study, efficiency of multidisciplinary PR in COPD patients with PH was examined.
88 patients stable COPD patients who applied to our center between 2008-2013 were enrolled. Un-likely PH patients were grouped as Group 1 while possible and likely PH cases were accepted as Group 2. There were no other cause for PH. All the patients received patient-specific, multidisciplinary 8-week PR. Dyspnea perception was assessed via MRC dyspnea scale, health-related quality of life with S. George life quality questionnaire, exercise capacity via incremental shuttle walking test and endurance shuttle walking test and body composition via bioelectrical impedance test before and after PR program.
In all the patients there were significant improvements in body composition (BMİ p= 0.013), quality of life (SGRQ semp., activity, total p< 0.001), dyspnea perception (MRC p< 0.001) and exercise capacity (ISWTT, ESWT, VO2 peak p< 0.001) after PR program. Improvements in Group 2 were observed to be significantly greater.
PR is an effective and safe option in COPD patients with PH. These patients should be directed to PH programs for supervised exercise training and chronic disease management and patient-specific PR programs should be established.
慢性阻塞性肺疾病(COPD)是继发性肺动脉高压(PH)最常见的病因之一。肺康复(PR)是COPD标准治疗方案中的推荐疗法。本研究对多学科肺康复在合并PH的COPD患者中的疗效进行了检测。
纳入2008年至2013年间前来我院就诊的88例病情稳定的COPD患者。无PH的患者被归为第1组,可能合并及确诊合并PH的患者被归为第2组。不存在其他导致PH的病因。所有患者均接受了为期8周的个体化多学科肺康复治疗。在肺康复治疗前后,通过医学研究委员会(MRC)呼吸困难量表评估呼吸困难感受,通过圣乔治生活质量问卷评估健康相关生活质量,通过递增往返步行试验和耐力往返步行试验评估运动能力,通过生物电阻抗测试评估身体成分。
在所有患者中,肺康复治疗后身体成分(体重指数p = 0.013)、生活质量(圣乔治生活质量问卷情绪、活动、总分p < 0.001)、呼吸困难感受(MRC p < 0.001)和运动能力(递增往返步行试验、耐力往返步行试验、最大摄氧量峰值p < 0.001)均有显著改善。第2组的改善更为显著。
肺康复对于合并PH的COPD患者是一种有效且安全的治疗选择。应指导这些患者参加肺动脉高压项目以接受监督下的运动训练和慢性病管理,并应制定个体化的肺康复方案。