简化“六字诀”联合体外膈肌起搏对COPD稳定期患者肺康复的疗效评价

方英; 方群; 王世强; 徐一凯; 李琴; 陈梅

doi:10.16766/j.cnki.issn.1674-4152.002141

简化“六字诀”联合体外膈肌起搏对COPD稳定期患者肺康复的疗效评价

doi: 10.16766/j.cnki.issn.1674-4152.002141

浙江中医药大学附属第三医院呼吸内科，浙江杭州 310000

基金项目:

浙江省中医药科技计划项目 2020ZB133

详细信息

通讯作者:
方群，E-mail：644436445@qq.com

中图分类号: R563
计量
- 文章访问数: 506
- HTML全文浏览量: 244
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-31
- 网络出版日期: 2022-02-15

Efficacy evaluation of simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation of patients with COPD stable period

Department of Respiratory Medicine, the Third Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的探究简化“六字诀”联合体外膈肌起搏在慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)稳定期患者肺康复治疗中的应用效果。方法选取2017年7月—2019年6月浙江中医药大学附属第三医院收治的120例COPD稳定期患者，按照随机数字表法分为4组，A组给予基础治疗，B组在A组基础上给予简化“六字诀”功法训练，C组在A组基础上给予体外膈肌起搏干预，D组在A组基础上给予简化“六字诀”功法训练联合体外膈肌起搏干预，每组30例，各组干预周期均为3个月。对比4组患者中医证候积分、BODE指数、生活质量、半年内急性加重次数。结果干预后，4组患者中医证候积分[(6.82±1.57)分、(5.26±1.34)分、(5.63±1.28)分、(4.52±1.15)分]、生活质量各维度评分及总分[(44.21±9.07)分、(37.91±8.65)分、(39.92±7.83)分、(32.42±8.26)分]、半年内急性加重次数[(4.25±1.26)次、(3.32±0.87)次、(3.86±1.03)次、(2.62±0.79)次]等指标均较干预前降低，D组明显低于A、B、C组，差异有统计学意义(P＜0.05);干预后4组BODE指数均较干预前下降，D组BODE指数[(4.21±1.04)分]均低于A、B、C组[(5.32±1.67)分、(4.84±1.40)分、(5.23±1.35)分]，与A、C组比较差异有统计学意义(均P＜0.05)。结论简化“六字诀”联合体外膈肌起搏用于COPD稳定期患者肺康复治疗中可有效缓解患者临床症状，增强肺功能，减少急性发作次数，降低BODE指数，提升生活质量。
- “六字诀”功法 /
- 体外膈肌起搏 /
- 慢性阻塞性肺疾病 /
- 肺功能 /
- 生活质量
Abstract: Objective To explore the effect of simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD) stable period. Methods A total of 120 patients with COPD stable period in our hospital were selected from July 2017 to June 2019, and they were randomly divided into four groups, with 30 cases in each group. Group A was given basic treatment, group B was given the simplified 'six-word formula' training on the basis of group A, group C was given extracorporeal phrenic pace-making on the basis of group A, and group D was given simplified 'six-word formula' training combined with extracorporeal phrenic pace-making on the basis of group A. The intervention period of each group was 3 months. The TCM syndrome score, BODE index, quality of life and times of acute exacerbation in half a year of the four groups were compared. Results After intervention, the scores of TCM syndromes (6.82±1.57, 5.26±1.34, 5.63±1.28, 4.52±1.15), the score of quality of life in each dimension and total scores (44.21±9.07, 37.91±8.65, 39.92±7.83, 32.42±8.26), and the number of acute exacerbations (4.25±1.26, 3.32±0.87, 3.86±1.03, 2.62±0.79) in half a year in the four groups of patients were decreased compared with those before the intervention. Group D had the lowest scores, and the difference was statistically significant (all P < 0.05). After the intervention, the BODE index of the four groups decreased. The BODE index of group D (4.21±1.04) was lower than that of group A, B and C (5.32±1.67, 4.84±1.40, 5.23±1.35, respectively), and the difference was statistically significant (all P < 0.05). Conclusion The simplified 'six-word formula' combined with extracorporeal phrenic pace-making in pulmonary rehabilitation can effectively alleviate the clinical symptoms of COPD stable period patients, enhance the pulmonary function, reduce the number of acute attacks, reduce the BODE index and improve the quality of life of COPD patients.
- 'Six-word formula' skill /
- Extracorporeal phrenic pace-making /
- Chronic obstructive pulmonary disease /
- Pulmonary function /
- Quality of life

HTML全文

表 1 BODE指数评分标准

项目	0分	1分	2分	3分
BMI	>21	≤21
FEV₁%pred(%)	≥65	50~64	36~49	≤35
mMRC(分)	0~1	2	3	4
6MWD(m)	≥350	250~349	150~249	≤149

下载: 导出CSV

表 2 4组COPD稳定期患者一般资料比较

组别	例数	性别(男/女，例)	年龄(x ±s，岁)	有吸烟史(例)	COPD病史(x ±s，年)	APACHE Ⅱ评分(x ±s，分)
A组	30	21/9	67.46±4.27	7	6.59±2.47	17.02±3.45
B组	30	18/12	66.73±5.03	5	7.28±2.80	16.13±4.26
C组	30	19/11	65.84±4.68	6	7.08±2.04	15.87±4.35
D组	30	23/7	67.27±4.53	9	6.53±2.12	16.59±3.82
统计量		2.241^a	0.735^b	1.673^a	0.719^b	0.487^b
P值		0.570	0.533	0.701	0.543	0.692
注：^a为χ²值，^b为F值。

下载: 导出CSV

表 3 4组COPD稳定期患者中医证候积分比较(x ±s，分)

组别	例数	干预前	干预后	t值	P值
A组	30	11.65±2.43	6.82±1.57^a	9.144	＜0.001
B组	30	10.79±2.26	5.26±1.34^a	11.528	＜0.001
C组	30	11.14±2.63	5.63±1.28^a	10.318	＜0.001
D组	30	10.82±2.17	4.52±1.15	14.051	＜0.001
F值		0.846	15.310
P值		0.472	＜0.001
注：与干预后D组比较，^aP＜0.05。

下载: 导出CSV

表 4 4组COPD稳定期患者BODE指数比较(x ±s，分)

组别	例数	干预前	干预后	t值	P值
A组	30	6.16±1.23	5.32±1.67^ab	2.218	0.030
B组	30	6.57±1.46	4.84±1.40	4.684	＜0.001
C组	30	6.21±1.28	5.23±1.35^a	2.885	0.005
D组	30	6.14±1.34	4.21±1.04	6.232	＜0.001
F值		0.693	3.998
P值		0.558	0.009
注：与干预后D组比较，^aP＜0.05;与干预后C组比较，^bP < 0.05。

下载: 导出CSV

表 5 4组COPD稳定期患者生活质量比较(x ±s，分)

组别	例数	呼吸症状		活动受限		疾病影响		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
A组	30	58.42±12.18	51.32±8.24^ab	52.25±11.46	45.73±7.54^ab	38.72±10.65	35.54±8.47^ab	49.82±10.87	44.21±9.07^ab
B组	30	57.89±11.54	45.76±7.35^ab	50.63±12.87	36.56±6.38^ab	40.67±12.20	31.58±7.21^ab	49.70±11.59	37.91±8.65^ab
C组	30	57.37±13.06	49.12±8.63^ab	50.73±10.72	38.24±6.38^ab	38.26±11.43	32.28±6.42^ab	48.73±12.34	39.92±7.83^ab
D组	30	59.52±10.42	40.21±7.18^b	51.49±12.33	30.73±5.62^b	39.78±10.84	26.45±7.18^b	50.64±11.75	32.42±8.26^b
F值		0.181	11.319	0.121	26.989	0.275	7.840	0.135	10.032
P值		0.909	＜0.001	0.947	＜0.001	0.843	＜0.001	0.939	＜0.001
注：与干预后D组比较，^aP＜0.05;与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(22)

[1]	MATHAR H, FASTHOLM P, LARSEN N S, et al. Self-reported illness behaviour related to chronic obstructive pulmonary disease and rehabilitation: A theory-guided qualitative study[J]. Scand J Caring Sci, 2020, 34(2): 484-491. doi: 10.1111/scs.12752
[2]	包鹤龄, 丛舒, 王宁, 等. 2014年中国慢性阻塞性肺疾病高危人群现状调查与分析[J]. 中华流行病学杂志, 2018, 39(5): 580-585. doi: 10.3760/cma.j.issn.0254-6450.2018.05.008
[3]	季思勤, 罗功汶, 沈谋, 等. 六字诀对慢性阻塞性肺疾病稳定期患者营养状况的临床研究[J]. 辽宁中医杂志, 2019, 46(7): 1428-1431. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201907031.htm
[4]	谢林艳, 葛林阳, 李涛, 等. 六字诀治疗慢性阻塞性肺疾病的价值及其应用[J]. 中华物理医学与康复杂志, 2020, 42(3): 285-286, 288. doi: 10.3760/cma.j.issn.0254-1424.2020.03.021
[5]	NIK A, ANDALIBI M S S, EHSAEI M R, et al. The efficacy of glasgow coma scale (GCS) score and acute physiology and chronic health evaluation (APACHE) Ⅱ for predicting hospital mortality of ICU patients with acute traumatic brain injury[J]. Bull Emerg Trauma, 2018, 6(2): 141-145. doi: 10.29252/beat-060208
[6]	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)[J]. 中国医学前沿杂志(电子版), 2014, 6(2): 67-79. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201402028.htm
[7]	张克敏. 中医内科学[M]. 北京: 科学出版社, 2008: 65-67.
[8]	郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 201-203.
[9]	OLIVARES A, VITACCA M, COMINI L, et al. Combining the pulmonary rehabilitation decisional score with the bode index and clinical opinion in assigning priority for pulmonary rehabilitation[J]. COPD, 2018, 15(3): 238-244. doi: 10.1080/15412555.2018.1531389
[10]	CHENG S L, LIN C H, WANG C C, et al. Comparison between COPD assessment test (CAT) and modified medical research council (mMRC) dyspnea scores for evaluation of clinical symptoms, comorbidities and medical resources utilization in COPD patients[J]. J Formos Med Assoc, 2019, 118(1 Pt 3): 429-435. http://www.ncbi.nlm.nih.gov/pubmed/30150099
[11]	NELSEN L, GATER A, PANTER C, et al. Understanding and measuring symptoms and health status in asthma COPD overlap: Content validity of the EXACT and SGRQ[J]. J Patient Rep Outcomes, 2017, 2(1): 18. doi: 10.1186/s41687-018-0038-5/fulltext.html
[12]	ZHI J, SHAN Q, LIANG L, et al. Low skeletal muscle area as a prognostic marker for chronic obstructive pulmonary disease in elderly patients admitted to ICU[J]. Sci Rep, 2019, 9(1): 19117. doi: 10.1038/s41598-019-55737-z
[13]	MARTINEZ F J, HAN M K, ALLINSON J P, et al. At the Root: Defining and halting progression of early chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2018, 197(12): 1540-1551. doi: 10.1164/rccm.201710-2028PP
[14]	秦茵茵, 刘鹢倩, 张德华, 等. 慢性阻塞性肺疾病患者肺功能下降与膈肌功能变化的相关性[J]. 中华生物医学工程杂志, 2017, 23(5): 369-370, 373. doi: 10.3760/cma.j.issn.1674-1927.2017.05.003
[15]	王志威, 黄怀. 体外膈肌起搏器联合呼吸反馈用于脑卒中后气管切开患者肺康复的疗效观察[J]. 中华生物医学工程杂志, 2016, 22(6): 511-514. doi: 10.3760/cma.j.issn.1674-1927.2016.06.014
[16]	侯红梅, 肖芸, 谢俊玲. 体外膈肌起搏器联合无创通气治疗慢性阻塞性肺疾病的临床研究[J]. 中国医学创新, 2019, 16(16): 143-146. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX201916040.htm
[17]	曾娟利, 谭双香, 胡瑞成, 等. 体外膈肌起搏对稳定期慢性阻塞性肺疾病患者的康复作用[J]. 国际呼吸杂志, 2019, 39(16): 1216-1221. doi: 10.3760/cma.j.issn.1673-436X.2019.16.004
[18]	侯敏燕, 崔晓萍. 精简六字诀对肺肾气虚COPD患者生存质量观察[J]. 光明中医, 2017, 32(24): 3518-3521. https://www.cnki.com.cn/Article/CJFDTOTAL-GMZY201724007.htm
[19]	刘云霞, 刘志华, 任翠萍, 等. 吸入舒利迭联合有氧运动及心肺康复训练对COPD患者心肺功能、BODE指数及运动耐量的影响[J]. 解放军预防医学杂志, 2019, 37(8): 130-131, 134. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYX201908058.htm
[20]	邓丽金, 张文霞, 陈锦秀. 六字诀与全身呼吸操对老年慢性阻塞性肺疾病患者呼吸功能影响的对比研究[J]. 康复学报, 2018, 28(3): 57-61. https://www.cnki.com.cn/Article/CJFDTOTAL-FYXB201803013.htm
[21]	刘太容, 罗碧如, 孔丽蕊, 等. 穴位按摩联合六字诀呼吸操对COPD稳定期患者炎性因子、免疫功能及预后的影响[J]. 四川医学, 2018, 39(5): 573-578. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX201805026.htm
[22]	季思勤, 罗功汶, 施克俭, 等. 六字诀干预慢性阻塞性肺疾病稳定期患者的临床研究[J]. 西部中医药, 2019, 32(4): 111-114. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZY201904031.htm