使用基于家庭的呼气末正压呼吸练习对 COPD 患者的影响。

Effects of breathing exercises using home-based positive pressure in the expiratory phase in patients with COPD.

机构信息

Respiratory and Critical Care Medicine, Wenzhou Medical University First Affiliated Hospital, Wenzhou, China.

Respiratory and Critical Care Medicine, Wenzhou Medical University First Affiliated Hospital, Wenzhou, China

出版信息

Postgrad Med J. 2019 Sep;95(1127):476-481. doi: 10.1136/postgradmedj-2019-136580. Epub 2019 Jul 22.

DOI:10.1136/postgradmedj-2019-136580

PMID:31332025

Abstract

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) commonly have higher intrinsic positive end-expiratory pressure (PEEPi). A breathing exercise programme strategy employing an appropriate PEEP may improve their pulmonary functional capacity, exercise tolerance and health-related quality of life. Breathing with an expiratory resistive load, which is a method of modulating spontaneous breathing against PEEPi, has not been fully studied in patients with COPD. The objective of this study was to investigate the role of changing spontaneous breathing in home-based conditions and regulating spontaneous breathing with breathing exercises in patients with COPD.

METHODS

This was a prospective randomised trial including 64 patients with a diagnosis of stage III or IV COPD. Patients were randomised into two groups: standard treatment and standard treatment combined with breathing exercise rehabilitation. The effects of the treatments on the COPD assessment test (CAT) score, 6-minute walk test (6MWT) results and pulmonary function were compared at 0, 6, 12 and 18 months within and between the two groups.

RESULTS

All outcomes showed no significant differences between the two groups at the beginning of the study, while the 6MWT and CAT scores exhibited clinically and statistically significant improvements (p<0.001) by the end of the study. At month 18, the change in the predicted percentage of forced expiratory volume in 1 s (FEV%pred) differed between the two groups (p<0.05). In addition, there were statistically significant differences in the 6MWT results, CAT scores and FEV%pred values between the baseline and month 18 (p<0.0001) in the intervention group.

CONCLUSIONS

Improvements in 6MWT results, pulmonary function and CAT scores are associated with a successful response to breathing against PEEPi in patients with COPD.

TRIAL REGISTRATION

This trial was registered at research registry.com (identifier research registry 4816).

摘要

背景

慢性阻塞性肺疾病（COPD）患者通常存在较高的内源性呼气末正压（PEEPi）。采用适当 PEEP 的呼吸锻炼计划策略可能会改善其肺功能、运动耐量和健康相关生活质量。使用呼气阻力负荷来调节自主呼吸对抗 PEEPi 的方法尚未在 COPD 患者中得到充分研究。本研究旨在探讨改变自主呼吸在家庭环境中的作用以及通过呼吸锻炼调节自主呼吸在 COPD 患者中的作用。

方法

这是一项前瞻性随机试验，纳入了 64 例 III 或 IV 期 COPD 患者。患者随机分为两组：标准治疗组和标准治疗联合呼吸锻炼康复组。在 0、6、12 和 18 个月时，比较两组间和组内治疗对 COPD 评估测试（CAT）评分、6 分钟步行试验（6MWT）结果和肺功能的影响。

结果

研究开始时，两组所有结局均无显著差异，而 6MWT 和 CAT 评分在研究结束时显示出具有临床和统计学意义的改善（p<0.001）。在 18 个月时，两组间预计 1 秒用力呼气量（FEV%pred）的变化存在差异（p<0.05）。此外，干预组的 6MWT 结果、CAT 评分和 FEV%pred 值在基线和 18 个月时均存在统计学差异（p<0.0001）。