不同运动策略对稳定期慢性阻塞性肺疾病患者的影响_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 李红 , 刘燕 , 唐健滨 , 张换春 , 李丽华

河北医科大学附属华北石油管理局总医院呼吸内科（河北任丘 062552）;

Corresponding author：

李红, Email: 77060229@qq.com

Keywords：

慢性阻塞性肺疾病; 康复训练; 运动策略

DOI：

10.7507/1671-6205.201803008

Video：

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目的比较不同运动策略对慢性阻塞性肺疾病（简称慢阻肺）患者的康复训练效果。方法收集 2016 年 1 月至 2017 年 1 月在华北石油管理局总医院呼吸内科门诊随访的慢阻肺患者 86 例，随机分为策略一组与策略二组，每组 43 例。在常规药物治疗及健康教育基础上，策略一组采用功率自行车训练，策略二组采用地面行走训练。在训练进行至 12 周及 24 周时分别比较两组训练前后第 1 秒用力呼气容积占预计值百分比（FEV₁%pred）、第 1 秒用力呼吸容积占用力肺活量百分比（FEV₁/FVC）、最大摄氧量（VO₂max）、6 分钟步行距离（6MWD）、BODE 指数、慢性阻塞性肺疾病评估测试（CAT）评分、改良英国医学研究委员会呼吸困难量表、Borg 呼吸困难评分是否有差异，并进行两组间比较。结果在训练进行至 12 周时策略一组、策略二组患者训练后各组指标均有改善，其中除肺功能指标外差异均有统计学意义（均 P<0.05）。同时两组患者康复运动后指标进行比较，策略一组各组数据均数较策略二组有好转，其中 VO₂max、6MWD、BODE 指数差异有统计学意义（均 P<0.05）。在训练进行至 24 周时策略一组、策略二组患者较 12 周时各组指标均有改善，其中 6MWD、BODE 指数、Borg 评分、CAT 评分结果差异有统计学意义（均P<0.05）。同时两组患者康复运动后指标进行比较，策略一组各组数据均数较策略二组有好转趋势，但差异均无统计学意义（均P>0.05）。结论在慢阻肺患者康复训练中，功率自行车训练在短期内具有一定的优势，但坚持训练后两种训练方式基本无明显差异。

Citation： 李红, 刘燕, 唐健滨, 张换春, 李丽华. 不同运动策略对稳定期慢性阻塞性肺疾病患者的影响. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 407-410. doi: 10.7507/1671-6205.201803008 Copy

1.	李群, 陈锋, 王晓霞, 等. 肺康复训练对不同严重度稳定期慢性阻塞性肺疾病的影响. 中国呼吸与危重监护杂志, 2014, 13(2): 130-135.
2.	Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Rrespir Crit Care Med, 2013, 187(4): 347-365.
3.	Mahais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med, 2008, 149(12): 869-878.
4.	吴学敏, 侯来永, 白伟, 等. 呼吸训练对缓解期老年重度 COPD 患者生存质量及日常生活活动的影响. 中国康复医学杂志, 2006, 21(4): 307-310.
5.	Spruit MA, Sinqh SJ, Garvey C, et al. An Official American Thoracic Society /European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6.	Moy ML, Martinez CH, Kadri R, et al. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res, 2016, 18(8): e215.
7.	Heerema-Poelman A, Stuive I, Wempe JB. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?. J Cardiopulm Rehabil Prev, 2013, 33(6): 419-426.
8.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
9.	Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med, 1998, 158 (5 Pt 1): 1384-1387.
10.	柴晶晶, 柳涛, 蔡柏蔷. 慢性阻塞性肺疾病评估测试中文版临床应用意义的评价. 中华结核和呼吸杂志, 2011, 34(4): 256-258.
11.	Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD, 2012, 9(1): 12-15.
12.	Medinas-Amorós M, Alorda C, Renom F, et al. Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index. Chron Respir Dis, 2008, 5(1): 7-11.
13.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华结核和呼吸杂志, 2007, 30(1): 8-17.
14.	文红, 高怡, 安嘉颖, 等. 无氧阈和高强度运动康复对慢性阻塞性肺疾病患者生活质量的影响. 中国呼吸与危重监护杂志, 2009, 8(6): 519-523.
15.	Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet, 1996, 348(9035): 1115-1119.
16.	Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med, 2011, 155(3): 179-191.
17.	Casaburi R. Skeletal muscle function in COPD. Chest, 2000, 117(5Suppl 1): 267S-271S.
18.	DeLisa JA. 呼吸功能障碍患者的康复. 见: 南登昆, 郭正成, 主译. 康复医学——理论与实践. 第 3 版. 西安: 世界图书出版社, 2004, 624-1228.
19.	Alekseev AE, Guzun R, Reyes S, et al. Restrictions in ATP diffusion within sarcomeres can provoke ATP-depleted zones impairing exercise capacity in chronic obstructive pulmonary disease. Biochim Biophys Acta, 2016, 1860(10): 2269-2278.
20.	Maltais F, LeBlanc P, Simard C, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 442-447.

1. 李群, 陈锋, 王晓霞, 等. 肺康复训练对不同严重度稳定期慢性阻塞性肺疾病的影响. 中国呼吸与危重监护杂志, 2014, 13(2): 130-135.
2. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Rrespir Crit Care Med, 2013, 187(4): 347-365.
3. Mahais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med, 2008, 149(12): 869-878.
4. 吴学敏, 侯来永, 白伟, 等. 呼吸训练对缓解期老年重度 COPD 患者生存质量及日常生活活动的影响. 中国康复医学杂志, 2006, 21(4): 307-310.
5. Spruit MA, Sinqh SJ, Garvey C, et al. An Official American Thoracic Society /European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6. Moy ML, Martinez CH, Kadri R, et al. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res, 2016, 18(8): e215.
7. Heerema-Poelman A, Stuive I, Wempe JB. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?. J Cardiopulm Rehabil Prev, 2013, 33(6): 419-426.
8. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
9. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med, 1998, 158 (5 Pt 1): 1384-1387.
10. 柴晶晶, 柳涛, 蔡柏蔷. 慢性阻塞性肺疾病评估测试中文版临床应用意义的评价. 中华结核和呼吸杂志, 2011, 34(4): 256-258.
11. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD, 2012, 9(1): 12-15.
12. Medinas-Amorós M, Alorda C, Renom F, et al. Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index. Chron Respir Dis, 2008, 5(1): 7-11.
13. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华结核和呼吸杂志, 2007, 30(1): 8-17.
14. 文红, 高怡, 安嘉颖, 等. 无氧阈和高强度运动康复对慢性阻塞性肺疾病患者生活质量的影响. 中国呼吸与危重监护杂志, 2009, 8(6): 519-523.
15. Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet, 1996, 348(9035): 1115-1119.
16. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med, 2011, 155(3): 179-191.
17. Casaburi R. Skeletal muscle function in COPD. Chest, 2000, 117(5Suppl 1): 267S-271S.
18. DeLisa JA. 呼吸功能障碍患者的康复. 见: 南登昆, 郭正成, 主译. 康复医学——理论与实践. 第 3 版. 西安: 世界图书出版社, 2004, 624-1228.
19. Alekseev AE, Guzun R, Reyes S, et al. Restrictions in ATP diffusion within sarcomeres can provoke ATP-depleted zones impairing exercise capacity in chronic obstructive pulmonary disease. Biochim Biophys Acta, 2016, 1860(10): 2269-2278.
20. Maltais F, LeBlanc P, Simard C, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 442-447.

Chinese Journal of Respiratory and Critical Care Medicine

不同运动策略对稳定期慢性阻塞性肺疾病患者的影响

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