Ries A L, Kaplan R M, Limberg T M, Prewitt L M
Division of Pulmonary and Critical Care Medicine, University of California, San Diego 92103-8377, USA.
Ann Intern Med. 1995 Jun 1;122(11):823-32. doi: 10.7326/0003-4819-122-11-199506010-00003.
To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.
Randomized clinical trial.
University medical center.
119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen.
Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training.
Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years.
Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS [P < 0.001]; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of -1.4 compared with -0.2 [P < 0.01]), shortness of breath (score of -7.0 compared with +0.6 [P < 0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up.
Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.
比较综合肺康复与单纯教育对慢性阻塞性肺疾病患者生理和心理社会结局的影响。
随机临床试验。
大学医学中心。
119例慢性阻塞性肺疾病门诊患者，在接受标准药物治疗期间病情稳定。
患者被随机分配到为期8周的综合肺康复计划或为期8周的教育计划中。肺康复包括12次每次4小时的课程，内容包括教育、身体和呼吸护理指导、心理社会支持以及有监督的运动训练。每月强化课程持续1年。教育组参加4次每次2小时的课程，内容包括录像带、讲座和讨论，但不包括个别指导或运动训练。
肺功能、最大运动耐量和耐力、气体交换、运动时的呼吸困难和肌肉疲劳症状、气短、步行自我效能感、抑郁、总体幸福感以及与肺部疾病相关的住院情况。对患者进行了6年的随访。
与单纯教育相比，综合肺康复在最大运动耐量方面有显著更大的提高（分别为增加1.5代谢当量[METS]和增加0.6 METS[P<0.001]；最大摄氧量分别为增加0.11升/分钟和增加0.03升/分钟[P = 0.06]）、运动耐力（分别为增加10.5分钟和增加1.3分钟[P<0.001]）、呼吸困难症状（评分分别为-1.5和+0.2[P<0.001]）和肌肉疲劳（评分分别为-1.4和-0.2[P<0.01]）、气短（评分分别为-7.0和+0.6[P<0.01]）以及步行自我效能感（评分分别为+1.4和+0.1[P<0.05]）。在生存率（分别为67%和56%[P = 0.32]）和住院天数（分别为每年每位患者减少2.4天和增加1.3天[P = 0.20]）方面存在轻微但无显著差异。两组在肺功能、抑郁和总体生活质量方面的测量指标没有差异。随访1年后差异趋于减小。
综合肺康复显著改善了中重度慢性阻塞性肺疾病患者的运动表现和症状。益处至少维持了1年，之后趋于减弱。
