Holle R H, Williams D V, Vandree J C, Starks G L, Schoene R B
Providence Hospital, Everett, WN 98206.
Chest. 1988 Dec;94(6):1161-8. doi: 10.1378/chest.94.6.1161.
Previous reports of pulmonary rehabilitation programs have demonstrated improvement in exercise capacity in subjects with disabling pulmonary disease. However, the cost-effectiveness, benefits to outpatients in a community setting, durability of these improvements, and mechanism of improved exercise capacity remain unclear. Forty-four patients with an average FEV1 of 33 +/- 4 percent of predicted completed a six-week long period of supervised treadmill exercise, as well as a continuing home program. Twenty percent had previously unsuspected cardiac disease discovered through the program, while 36 percent had previously unsuspected exercise desaturation. Cardiopulmonary stress testing before and after the program revealed a 73 +/- 16 percent improvement in aerobic capacity (METs peak [power]) and a 250 +/- 78 percent improvement in endurance (MET-min [work]). No significant change was seen in VE max, HR max, FEV1, or the degree of exercise desaturation. Only a small improvement was noted in VO2 max (15 +/- 8 percent) and O2 pulse (16 +/- 8 percent), suggesting that most of the improvement was due to improved muscle efficiency. Follow-up testing at 12 +/- 3 months in 24 subjects revealed that 89 +/- 7 percent of the peak exercise performance was maintained. The cost of the basic program was +800. The results demonstrated that an outpatient community hospital pulmonary rehabilitation program can accomplish substantial exercise capacity improvement with sustained benefits in a cost-effective manner.
先前关于肺康复计划的报告表明，患有致残性肺部疾病的受试者的运动能力有所改善。然而，这些改善的成本效益、对社区环境中门诊患者的益处、这些改善的持久性以及运动能力改善的机制仍不清楚。44名平均FEV1为预测值的33±4%的患者完成了为期六周的有监督的跑步机运动，以及持续的家庭计划。通过该计划发现20%的患者先前患有未被怀疑的心脏病，而36%的患者先前存在未被怀疑的运动性血氧饱和度下降。在该计划前后进行的心肺压力测试显示，有氧能力（最大代谢当量[功率]）提高了73±16%，耐力（代谢当量-分钟[功]）提高了250±78%。最大通气量、最大心率、FEV1或运动性血氧饱和度下降程度均无显著变化。仅最大摄氧量（15±8%）和氧脉搏（16±8%）有小幅改善，这表明大部分改善是由于肌肉效率提高。对24名受试者在12±3个月时进行的随访测试显示，89±7%的峰值运动表现得以维持。基本计划的成本为800美元。结果表明，社区医院门诊肺康复计划可以以具有成本效益的方式实现运动能力的显著改善，并带来持续的益处。
