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以调节呼吸运动为重点的肺康复可改善新型冠状病毒肺炎重症患者的预后。

Pulmonary rehabilitation focusing on the regulation of respiratory movement can improve prognosis of severe patients with COVID-19.

作者信息

Sun Jiaolin, Liu Jia, Li Hong, Shang Cuixia, Li Tingting, Ji Wenwen, Wu Jing, Han Xu, Shi Zhihong

机构信息

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Rehabilitation Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

出版信息

Ann Palliat Med. 2021 Apr;10(4):4262-4272. doi: 10.21037/apm-20-2014. Epub 2021 Mar 23.

Abstract

BACKGROUND

Since the coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, it has become a global public health emergency. Besides conventional care, pulmonary rehabilitation (PR) is an equally important treatment for patients with COVID-19 suffering from respiratory, physical and psychological disease. The aim of this study is to investigate the role of PR on the inpatients with severe COVID-19.

METHODS

This study was a self-pre- and post-control prospective clinical trial, which totally recruited 31 inpatients confirmed COVID-19 by RT-PCR. They were performed 3-week PR. The demographic data, medical records, symptoms, laboratory findings and chest computed tomographic (CT) scans of patients were collected at baseline. The effect of PR was assessed by questionnaires before PR as well as after 2- and 3-week PR.

RESULTS

After 3-week PR and treatment, neutrophil percentage decreased, while lymphocyte percentage and lymphocyte count increased (before vs. 2 weeks after PR respectively: P=0.001; P=0.001; P<0.0001). Besides, CRP and procalcitonin reduced significantly (before vs. after respectively: P<0.0001; P=0.023). Patients' oxygen intake decreased and oxygen saturation increased significantly. Meanwhile, PR relieved the patients' symptoms of cough and dyspnea, improved the patients' self-care ability, physical fitness and mental state significantly. Activities of daily living (ADL) score increased and Modified Medical Research Council Dyspnea Scale (mMRC) decreased after PR.

CONCLUSIONS

PR can relieve symptoms, enhance health-related quality of life, improve respiratory muscle function and alleviate disease-related anxiety and depression of severe patients with COVID-19. PR should be provided throughout the diseases management process, regardless of whether the patient is hospitalized or at home.

摘要

背景

自2019年冠状病毒病(COVID-19)在中国武汉出现以来,它已成为全球突发公共卫生事件。除了常规护理外,肺康复(PR)对于患有呼吸、身体和心理疾病的COVID-19患者而言是同样重要的治疗方法。本研究的目的是探讨PR对重症COVID-19住院患者的作用。

方法

本研究是一项自身前后对照的前瞻性临床试验,共招募了31例经逆转录聚合酶链反应(RT-PCR)确诊为COVID-19的住院患者。他们接受了为期3周的PR。在基线时收集患者的人口统计学数据、病历、症状、实验室检查结果和胸部计算机断层扫描(CT)。在PR前以及PR 2周和3周后通过问卷调查评估PR的效果。

结果

经过3周的PR和治疗后,中性粒细胞百分比下降,而淋巴细胞百分比和淋巴细胞计数增加(PR前与PR后2周分别比较:P = 0.001;P = 0.001;P < 0.0001)。此外,C反应蛋白(CRP)和降钙素原显著降低(PR前与PR后分别比较:P < 0.0001;P = 0.023)。患者的吸氧需求下降,血氧饱和度显著增加。同时,PR缓解了患者的咳嗽和呼吸困难症状,显著提高了患者的自我护理能力、身体素质和精神状态。PR后日常生活活动(ADL)评分增加,改良医学研究理事会呼吸困难量表(mMRC)评分降低。

结论

PR可以缓解症状,提高与健康相关的生活质量,改善呼吸肌功能,并减轻重症COVID-19患者与疾病相关的焦虑和抑郁。在整个疾病管理过程中都应提供PR,无论患者是住院还是在家中。

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