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目的探讨区级医院对慢性阻塞性肺疾病(简称慢阻肺)急性发作期患者出院后早期实施呼吸康复(PR)的可行性和疗效。方法采用单中心随机对照研究方法,选择2013年1月至2014年12月因慢阻肺急性加重在我院或外院住院治疗,经治疗后好转出院并在我院内科门诊随访的患者,随机分为呼吸康复组(PR组)和无呼吸康复组(without PR,w PR组),两组患者除了是否使用PR外,其余治疗均按照我国指南要求。所有患者入组时均记录性别、年龄,用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%pred);对患者分别记录和比较进行综合性PR前后医学研究会呼吸困难量表(MRC)、圣乔治呼吸问卷(SGRQ)、6分钟步行距离(6MWD)。结果共入组符合标准的患者91例,其中PR组46例,w PR组45例。两组患者性别、年龄、慢阻肺分级无显著差异(P>0.05)。PR组患者3个月后MRC评分、SGRQ评分较基线水平均显著下降(P<0.05),而w PR组患者差异无统计学意义(P>0.05),其中PR组SGRQ分数下降>4分26例(26/46,56.5%),显著高于w PR组的7例(7/45,15.6%)(P<0.05)。PR组患者3个月后6MWD较基线水平显著增加(P<0.05),而w PR组患者差异无统计学意义(P>0.05)。其中PR组6MWD增加>54 m 22例(22/46,47.8%),显著高于w PR组的9例(9/45,20.0%)(P<0.05)。结论区级医院对慢阻肺急性加重患者出院后早期实施PR是安全可行的,它可以改善患者的MRC、SGQR评分和增加6MWD。
Objective To investigate the feasibility and efficacy of district hospitals in the early implementation of respiratory rehabilitation (PR) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A single-center randomized controlled study was conducted. Patients who were hospitalized in our hospital or outside hospital due to acute exacerbation of chronic obstructive pulmonary disease from January 2013 to December 2014 were selected and randomly divided into patients who were discharged after treatment and followed up in internal medicine department of our hospital For the respiratory rehabilitation group (PR group) and non-respiratory rehabilitation group (without PR, w PR group), the two groups of patients in addition to the use of PR, the rest of the treatment are in accordance with our guidelines. All patients were enrolled in the record of gender, age, forced vital capacity (FVC), forced expiratory volume 1 second (FEV1), FEV1 percentage of predicted value (FEV1% pred) Medical Research Dyspnea Scale (MRC), St. George’s Respiratory Questionnaire (SGRQ), 6-minute walking distance (6MWD). Results A total of 91 patients were enrolled in this study. Among them, 46 patients in PR group and 45 patients in w PR group. Two groups of patients sex, age, chronic obstructive pulmonary grading no significant difference (P> 0.05). The MRC score and the SGRQ score of the PR group were significantly lower than those of the baseline level after 3 months (P <0.05), while there was no significant difference between the WPR group and the PR group (P> 0.05). The SGRQ score of the PR group decreased more than 4 points Cases (26/46, 56.5%) were significantly higher than those in the w PR group (7/45, 15.6%, P <0.05). 6MWD in PR group was significantly higher than baseline level after 3 months (P <0.05), while there was no significant difference in w PR group (P> 0.05). There were 22 cases (22/46, 47.8%) with 6MWD increasing> 54 m in PR group, which was significantly higher than that in 9 cases (9/45, 20.0%) in w PR group (P <0.05). Conclusion District-level hospitals are safe and feasible in the early stage of PR after discharged from patients with acute exacerbation of COPD, which can improve MRC and SGQR scores of patients and increase 6MWD.