一种新型改良的吸气肌联合呼气肌阈值负荷锻炼器在慢性阻塞性肺疾病肺康复中的应用及效果评价

发布时间：2018-05-20 03:11

本文选题：慢性阻塞性肺疾病 + 呼吸肌疲劳　；参考：《南方医科大学》2017年硕士论文

【摘要】：[背景]肺康复是目前COPD稳定期患者治疗的一个重要手段,其中呼吸肌锻炼是肺康复的重要组成部分。吸气肌锻炼已被证实可以提高COPD患者的呼吸肌肉功能,缓解COPD患者呼吸困难程度,但是吸气肌联合呼气肌锻炼的康复效果目前仍存在较多争议。采用阈值负荷呼吸肌锻炼装置可以根据患者的呼吸肌功能准确调节锻炼负荷,目前已得到广泛应用。国内外有关呼吸肌联合锻炼通常采用吸气肌和呼气肌分别进行锻炼的方式。国内“水封式”阈值负荷呼吸肌锻炼装置可以实现在同一呼吸周期内完成吸气肌和呼气肌的联合锻炼,但其存在装置体积较大、不易携带、可调节压力负荷范围小等缺陷。本研究在其可持续锻炼的基础上进行改良,设计并构造一种新型的体积较小、方便携带、可调阈值负荷更大的呼吸肌联合锻炼装置。[目的]本研究拟比较吸气肌锻炼与两种不同方式呼吸肌联合锻炼的COPD患者肺康复效果,探讨吸气肌和呼气肌联合锻炼与单一吸气肌锻炼相比是否能带来额外的获益。本研究拟设计并构造一种新型的、可实现吸呼相持续进行呼吸肌锻炼的阈值负荷锻炼器,并比较使用该新型锻炼器进行呼吸肌联合锻炼与传统的分解式联合锻炼及单纯吸气肌锻炼模式对于COPD患者的肺康复效果是否存在差异。[方法]本研究按照纳入及排除标准收集南方医科大学珠江医院呼吸内科门诊COPD稳定期患者95例,随机分成4组:对照组(the control group)、单一吸气肌锻炼组(inspiratory muscle training group,IMT)、完整吸呼相呼吸肌联合锻炼组(concurrent inspiratory and expiratory muscle training group,CRMT)、分解吸呼相呼吸肌联合锻炼组(separated inspiratory and expiratory muscle training group,SRMT),对照组不参加任何的呼吸肌锻炼,IMT、CRMT、SRMT三组分别进行为期8周的不同方案的呼吸肌锻炼。锻炼前后分别测试COPD肺康复患者的静态肺功能、最大吸气压(massive inspiratory pressure,MIP)、最大呼气压(massive expiratory pressure,MEP)、呼吸困难症状评分(mMRC score)、6分钟步行试验距离(6-min walking test distance,6MWD)、生活质量评分(St.George's Respiratory Questionnaire,SGRQ)和抑郁、焦虑评分(Hospital depression and anxiety scale,HAD),比较使用改良的阈值负荷锻炼器与传统的分解式联合锻炼和单纯的吸气肌锻炼的康复效果。[结果]构造了一种新型改良的阈值负荷的呼吸肌锻炼器,可以实现在同一个完整呼吸周期连续进行吸气肌锻炼和呼气肌锻炼。IMT组的脱落率为8.70%,CRMT组的脱落率为12.50%,SRMT组的脱落率为 18.52%。与对照组相比,IMT、CRMT、SRMT三组肺康复锻炼前后各组静态肺功能指标用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积占预计值的百分比(FEV1%pred)及6MWD的差异均无显著统计学差异(P0.05)。IMT组、CRMT组、SRMT组的MIP锻炼后较锻炼前分别提高9.791±6.870cmH_2O、9.938±6.987cmH_2O、8.073±6.692cmH_2O(P 均0.05),三组的改善幅度无明显差异(P0.05),但显著高于对照组(P0.05,对照组的改善幅度为1.928±4.429)。IMT、CRMT、SRMT三组的MEP锻炼后较锻炼前分别提高4.276±4.067 cmH20、9.243±8.404 cmH20、7.096±7.954 cmH20(P均0.05)。除 IMT 组外,CRMT 和SRMT两组的MEP的改善幅度显著高于对照组(P=0.008和P=0.036),但两组间无明显统计学差异(P0.05)。IMT、CRMT、SRMT三组的mMRC评分锻炼后较锻炼前分别提高0.381±0.498 分、0.286±0.463 分、0.273±0.456 分(P=0.002,P=0.010 和 P=0.011),三组间无明显统计学差异(P0.05)。IMT、CRMT、SRMT三组的SGRQ评分锻炼后较锻炼前分别下降3.191±1.778、4.000±2.074、2.636±2.752(P均0.05),三组间无明显统计学差异(P0.05),但改善幅度显著高于对照组(P均0.05,对照组下降幅度为0.350±2.739)。IMT、CRMT、SRMT三组的CAT评分锻炼后较锻炼前分别下降2.238±2.700、2.714±2.306、1.818±1.622(P均0.05),三组间无明显统计学差异(P0.05),改善幅度显著高于对照组(P均0.05,对照组下降幅度为0.250±2.049)。各组间肺康复锻炼前后BODE指数、抑郁、焦虑评分锻炼前后的差值无统计学意义(P0.05)。IMT组吸气肌肌力低下的患者MIP的改善幅度优于吸气肌肌力正常的患者(P0.05),SRMT组吸气肌肌力低下的患者MIP、MEP的改善幅度优于吸气肌肌力正常的患者(P0.05)。CRMT组吸气肌肌力低下的患者MIP、MEP的改善程度与吸气肌肌力正常的患者相比无明显统计学差异(P均0.05)。IMT、CRMT、SRMT三组吸气肌肌力低下的患者肺功能、mMRC评分、6WMD、SGRQ评分、HAD评分、BODE评分的改善程度与吸气肌正常的患者相比无明显差异(P0.05)。[结论]使用新型改良的呼吸肌联合锻炼器(CRMT)可显著提高MIP、MEP,mMRC评分、SGRQ评分、CAT评分,与SRMT的康复效果无显著差异,但是改良的呼吸肌联合锻炼器存在结构完整、携带方便、患者依从性高等优势。两种呼吸肌联合锻炼方案在改善MIP、mMRC评分、SGRQ评分、CAT评分与IMT组相比无明显差异,但是在改善MEP上优于IMT。IMT、CRMT、SRMT三组改善肺功能、6MWD、BODE指数、HAD评分上效果不显著。IMT组、CRMT组、SRMT组吸气肌肌力低下的患者在进行呼吸肌锻炼后与吸气肌肌力正常的患者相比:IMT组的MIP改善更显著,SRMT组的MIP和MEP改善更显著,两组其余指标改善不明显,CRMT组各指标的改善幅度无明显差异。在后期改良设计中,在不同的呼吸肌阈值负荷锻炼器上安装数据采集管理装置,实时记录患者的锻炼时间、频率、强度,监控患者的依从性和使用情况,精准评估呼吸肌锻炼的肺康复效果。
[Abstract]:[background] pulmonary rehabilitation is an important means for the treatment of COPD stable patients at present, in which the respiratory muscle exercise is an important part of the pulmonary rehabilitation. The inspiratory muscle exercise has been proved to improve the respiratory and muscle function of the patients with COPD and alleviate the difficulty of breathing in COPD patients. However, the rehabilitation effect of the inhalation muscle combined with the exhalation muscle is still still stored. There are many disputes. A threshold load breathing muscle exercise device can be used to adjust the exercise load accurately according to the respiratory muscle function of the patient. It has been widely used at present. The breathing muscles and the exhalation muscles are usually used for exercise at home and abroad. The domestic "water sealed" threshold load breathing muscle exercise device can be used in China. In order to achieve the combined exercise of the aspirated and exhalation muscles in the same breathing cycle, the device has a large volume, not easy to carry, and can regulate the small pressure load. This study is improved on the basis of its sustainable exercise, designed and constructed a new type of smaller size, convenient to carry, and a greater adjustable threshold load. [Objective] the purpose of this study is to compare the pulmonary rehabilitation effects of the COPD patients with two different ways of breathing muscle combined exercise. The purpose of this study is to explore whether the combined exercise of the inhalation and exhalation muscles can bring additional benefits compared with the single inspiratory muscle exercise. A threshold load exercise device for breathing muscle exercises is continued, and there is a comparison of whether there is a difference between the combined exercise of respiratory muscles with the traditional decomposed exercise and the simple inspiratory muscle exercise pattern for COPD patients. [Methods] this study collected the Southern Medical University according to the inclusion and exclusion criteria. 95 patients with COPD stable period in the Department of respiratory medicine in Zhujiang Hospital were randomly divided into 4 groups: the control group (the control group), the single inspiratory muscle exercise group (inspiratory muscle training group, IMT), the complete respiratory muscle combined exercise group (concurrent inspiratory and), and the decomposition of respiratory muscle coupling The exercise group (separated inspiratory and expiratory muscle training group, SRMT), the control group did not participate in any respiratory muscle exercise, IMT, CRMT, SRMT three groups for 8 weeks of different schemes of respiratory muscle exercise. Ure, MIP), the maximum expiratory pressure (massive expiratory pressure, MEP), the respiratory dyspnea symptom score (mMRC score), the 6 minute walk test distance (6-min walking test distance), the quality of life score and the depression, and the anxiety score. The rehabilitation effect of good threshold load exercise apparatus and traditional decomposing combined exercise and simple inhalation muscle exercise. [results] a new improved threshold load breathing muscle exercise device is constructed, which can realize the exfoliation rate of 8.70% group in the group of.IMT in the same complete breathing cycle and the exhalation muscle group, CRMT group. The rate of exfoliation was 12.50%, and the loss rate of group SRMT was 18.52%., compared with the control group, IMT, CRMT, and SRMT three groups before and after lung rehabilitation exercise, the static lung function index (FVC), the first second forced expiratory volume (FEV1), the percentage of the first second forced expiratory volume (FEV1%pred) and 6MWD had no significant difference (FEV1%pred) and 6MWD (FEV1%pred). P0.05) in group.IMT, group CRMT and group SRMT, MIP was increased by 9.791 + 6.870cmH_2O, 9.938 + 6.987cmH_2O, and 8.073 + 6.692cmH_2O (P 0.05), respectively. There was no significant difference between the three groups (P0.05), but significantly higher than the control group (P0.05, the improvement of the control group was 1.928 + 4.429). 4.276 + 4.067 cmH20,9.243 + 8.404 cmH20,7.096 + 7.954 cmH20 (P 0.05) respectively. Except IMT group, the improvement of MEP in CRMT and SRMT two groups was significantly higher than that of the control group (P=0.008 and P=0.036), but there was no significant difference between the two groups (P0.05).IMT. 0.286 + 0.463 points, 0.273 + 0.456 (P=0.002, P=0.010 and P=0.011), there was no significant difference between the three groups (P0.05),.IMT, CRMT, SRMT three after exercise decreased 3.191 + 1.778,4.000 + 2.074,2.636 + 2.752 (P 0.05) before exercise, and there was no significant difference between the three groups (P0.05), but the improvement was significantly higher than that of the control group. 0.05, the decrease of the control group was 0.350 + 2.739).IMT, and the CAT score in the group of CRMT and SRMT was decreased by 2.238 + 2.700,2.714 + 2.306,1.818 + 1.622 (P 0.05) before exercise. There was no significant difference between the three groups (P0.05), and the improvement was significantly higher than that of the control group (P 0.05, the control group was 0.250 + 2.049). The difference between the BODE index, depression and anxiety score before and after exercise was not statistically significant (P0.05) the improvement of MIP in the patients with low inspiratory muscle strength in the group.IMT was better than that of the patients with normal inspiratory muscle strength (P0.05), and in the SRMT group, the patients with low inspiratory muscle strength, MIP, and MEP were better than those in the patients with normal inspiratory muscle strength (P0.05).CRMT group. There was no significant difference in the improvement degree of MIP and MEP in the patients with low inspiratory muscle strength (P 0.05).IMT, CRMT, SRMT three, the mMRC score, 6WMD, SGRQ score, HAD score, BODE score had no significant difference compared with those of the normal aspirated patients (P0.). 05) [Conclusion] using a new modified respiratory muscle joint exercise device (CRMT) can significantly improve MIP, MEP, mMRC score, SGRQ score, CAT score, and no significant difference from SRMT, but the improved respiratory muscle joint exercise device has a complete structure, convenient carrying, and higher compliance with the patient. Two kinds of respiratory muscle joint exercise program can improve MI P, mMRC score, SGRQ score, and CAT score were not significantly different from those in the IMT group, but the improvement of MEP was superior to IMT.IMT, CRMT, and SRMT three groups to improve lung function, 6MWD, BODE index, and HAD scores were not significant. The improvement of MIP was more significant. The improvement of MIP and MEP in group SRMT was more significant. The improvement of the other indexes in the two groups was not obvious. There was no obvious difference in the improvement of each index in the CRMT group. In the later period of improvement, the data collection management device was installed on different respiratory muscle threshold load trainer to record the time, frequency, intensity, monitoring of patients' exercise time, frequency, intensity, and monitoring patients. The compliance and usage of the respiratory muscle exercise were evaluated accurately.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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