郑氏卧位康复操联合呼吸排痰阀对重度慢性阻塞性肺疾病患者的疗效观察

黄晓晨; 张永; 钱朝霞

doi:10.16766/j.cnki.issn.1674-4152.002859

郑氏卧位康复操联合呼吸排痰阀对重度慢性阻塞性肺疾病患者的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002859

1.
蚌埠医学院附属蚌埠市第三人民医院呼吸与危重症医学科，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院呼吸与危重症医学科，安徽蚌埠 233004

基金项目:

安徽省重点研究与开发计划项目 1804h08020287

蚌埠市科技创新指导类项目 20200314

蚌埠医学院校级重点项目 2020byzd378

详细信息

通讯作者:
钱朝霞，E-mail：2603525096@qq.com

中图分类号: R563 R493
计量
- 文章访问数: 184
- HTML全文浏览量: 37
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-01-27
- 网络出版日期: 2023-04-20

Clinical observation of Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve on patients with severe chronic obstructive pulmonary disease

1.
Department of Respiratory and Critical Care Medicine, Bengbu Third People's Hospital Affiliated to Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨重度慢性阻塞性肺疾病(COPD)患者进行郑氏卧位康复操联合呼吸排痰阀训练的临床效果。方法收集2020年10月—2021年2月蚌埠市第三人民医院呼吸内科治疗的重度慢性阻塞性肺疾病急性加重期(AECOPD)患者62例，采用随机数字表法分为观察组(31例)和对照组(31例)，均给予抗感染、解痉祛痰、氧疗等基础治疗。对照组进行缩唇腹式康复治疗，观察组采用郑氏卧位康复操联合呼吸排痰阀治疗，研究周期为12周。观察2组患者干预前后第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)、第1秒用力呼气容积与用力肺活量的比值(FEV₁/FVC)、CRP、IL-6、CD3⁺、CD4⁺、CD45⁺、慢性阻塞性肺疾病评估测试(CAT)及改良英国医学研究学会呼吸困难量表(mMRC)。结果干预后，观察组IL-6[6.11(0.82，10.83)pg/mL]和CRP[9.15(2.15，18.91)mg/L]较对照组显著降低[8.64(5.41，15.54)pg/mL、18.64(6.49，26.15)mg/L，均P < 0.05]，CD3⁺、CD4⁺及CD45⁺较对照组显著升高(均P < 0.05)，CAT评分[(28.03±4.53)分]和mMRC分级[(3.10±0.70)级]较对照组改善[(28.77±4.31)分、(3.45±0.62)级，均P < 0.05]，干预前后2组FEV₁、FVC、FEV₁/FVC差异均无统计学意义(均P>0.05)。结论郑氏卧位康复操联合呼吸排痰阀能够有效减轻患者的炎症反应，增强机体免疫功能，改善患者的呼吸困难症状，使肺功能维持稳定。
- 郑氏卧位康复操 /
- 呼吸排痰阀 /
- 慢性阻塞性肺疾病 /
- 炎症因子 /
- 免疫功能
Abstract: Objective To investigate the clinical effect of Zheng's clinostatic rehabilitation exercise combined with breathing and expelling valve training in patients with severe chronic obstructive pulmonary disease. Methods A total of 62 patients with acute exacerbation of severe chronic obstructive pulmonary disease (AECOPD) admitted to the Respiratory Department of Bengbu Third People's Hospital from October 2020 to February 2021 were divided into observation group (n=31) and control group (n=31) by random number table method. All patients were given basic treatment such as anti-infection, antispasmolysis and expectoration and oxygen therapy. The control group received lip-shrinking abdominal rehabilitation treatment, and the observation group received Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve. The study period was 12 weeks. Forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, CRP, IL-6, CD3⁺, CD4⁺, CD45⁺, COPD assessment test (CAT) and modified British medical research council (mMRC) were observed in the two groups before and after intervention. Results After intervention, the levels of IL-6 [6.11(0.82, 10.83) pg/mL] and CRP [9.15(2.15, 18.91) mg/L] in the observation group were significantly lower than those in the control group [8.64(5.41, 15.54) pg/mL, 18.64(6.49, 26.15) mg/L, all P < 0.05]. The levels of CD3⁺, CD4⁺ and CD45⁺ in the observation group were significantly higher than those in control group (all P < 0.05). CAT [(28.03±4.53) points] and mMRC (3.10±0.70) in the observation group was improved compared with that in the control group [(28.77±4.31) points, 3.45±0.62, all P < 0.05]. No significant differences in FEV₁, FVC and FEV₁/FVC were found in the two groups before and after intervention (all P>0.05). Conclusion Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve can effectively reduce inflammatory response, enhance immune function, improve dyspnoea and maintain stable lung function.
- Zheng' s clinostatic rehabilitation exercise /
- Respiratory expectoration valve /
- Chronic obstructive pulmonary disease /
- Inflammatory factors /
- Immune function

HTML全文

表 1 2组AECOPD患者干预前后肺功能指标比较(x±s)

Table 1. Comparison of lung function indexes in 2 groups of AECOPD patients before and after intervention (x±s)

组别	例数	FEV₁(L)		FVC(L)		FEV₁/FVC(%)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	31	0.99±0.28	0.93±0.35	1.68±0.45	1.59±0.57	59.39±7.63	59.26±7.98
观察组	31	0.95±0.32	0.96±0.31	1.64±0.54	1.60±0.51	58.58±6.41	60.50±6.17
t值		1.037	1.044	0.705	0.314	0.910	1.230
P值		0.308	0.305	0.486	0.755	0.370	0.228

下载: 导出CSV

表 2 2组AECOPD患者干预前后炎症因子水平比较[M(P₂₅, P₇₅)]

Table 2. Comparison of the levels of inflammatory cytokines in 2 groups of AECOPD patients before and after intervention [M(P₂₅, P₇₅)]

组别	例数	IL-6(pg/mL)		CRP(mg/L)
组别	例数	干预前	干预后	干预前	干预后
对照组	31	10.57(6.47，17.54)	8.64(5.41，15.54)	11.36(4.12，20.97)	18.64(6.49，26.15)
观察组	31	9.47(5.48，15.63)	6.11(0.82，10.83)^a	10.89(6.16，21.54)	9.15(2.15，18.91)^a
t值		0.612	2.020	0.162	1.992
P值		0.540	0.043	0.871	0.046
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

表 3 2组AECOPD患者干预前后免疫功能指标比较[M(P₂₅, P₇₅), /μL]

Table 3. Comparison of immune function indexes in 2 groups of AECOPD patients before and after intervention [M(P₂₅, P₇₅), /μL]

组别	例数	CD3⁺		CD4⁺		CD45⁺
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	31	550(354，745)	584(325，726)	988(679，1 324)	967(679，1 345)	1 447(987，1 856)	1 452(987，1 864)
观察组	31	510(308，832)	689(547，902)^a	1 021(698，1 301)	1 158(878，1 598)^a	1 312(872，1 654)	1 708(1 079，2 024)^a
Z值		0.507	2.224	0.443	1.999	1.274	2.133
P值		0.612	0.026	0.657	0.046	0.203	0.033
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

表 4 2组AECOPD患者干预前后呼吸困难评分指标比较(x±s)

Table 4. Comparison of dyspnea scoring indexes in 2 groups of AECOPD patients before and after intervention (x±s)

组别	例数	CAT(分)		mMRC(级)
组别	例数	干预前	干预后	干预前	干预后
对照组	31	28.03±6.26	28.77±4.31	3.52±0.57	3.45±0.62
观察组	31	28.58±6.35	28.03±4.53^a	3.39±0.71	3.10±0.70^a
t值		1.948	2.531	0.941	2.356
P值		0.061	0.017	0.354	0.025
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

参考文献(16)

[1]	World Health Organization. Chronic obstructive pulmonary disease (COPD)[EB/OL]. (2022-05-20)[2022-05-28]. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(COPD).
[2]	Global Initiative For Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2022 report[EB/OL]. (2021-11-15)[2021-12-15]. https://goldcopd.org/gold-reports/.
[3]	RYRS C K, GODTFREDSEN N S, KOFOD L M, et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis[J]. BMC Pulm Med, 2018, 18(1): 154. doi: 10.1186/s12890-018-0718-1
[4]	沈科, 陈华芳. 郑氏卧位康复操对重度慢性阻塞性肺疾病稳定期患者的疗效探讨[J]. 中国社区医师, 2019, 35(28): 180-181. doi: 10.3969/j.issn.1007-614x.2019.28.122 SHEN K, CHEN H F. Effect of Zheng's lying position rehabilitation exercise on patients with severe chronic obstructive pulmonary disease in stable stage[J]. Chinese Community Doctors, 2019, 35(28): 180-181. doi: 10.3969/j.issn.1007-614x.2019.28.122
[5]	HALPIN D, CELLI B R, CRINER G J, et al. The GOLD Summit on chronic obstructive pulmonary disease in low and middle income countries[J]. Int J Tuberc Lung Dis, 2019, 23(11): 1131-1141. doi: 10.5588/ijtld.19.0397
[6]	HANSEN H, BIELER T, BEYER N, et al. Supervised pulmonary telerehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial[J]. Thorax, 2020, 75(5): 413-421. doi: 10.1136/thoraxjnl-2019-214246
[7]	王辰, 迟春花, 陈荣昌, 等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002 WANG C, CHI C H, CHEN R C, et al. Guideline for primary care of chronic obstructive pulmonary disease (2018)[J]. Chinese JOurnal of General Practitioners, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002
[8]	王园, 刘妮, 杨峰, 等. 多功能呼气阀的原理及临床应用[J]. 国际呼吸杂志, 2018, 38(19): 1491-1494. doi: 10.3760/cma.j.issn.1673-436X.2018.19.010 WANG Y, LIU N, YANG F, et al. Principle and clinical application of multifunctional exhalation valve[J]. International Journal of Respiration, 2018, 38(19): 1491-1494. doi: 10.3760/cma.j.issn.1673-436X.2018.19.010
[9]	李洁, 刘蕊, 陈葆青. 深呼吸训练器大负荷吸气肌训练对稳定期COPD患者肺功能和运动耐力的影响[J]. 中国医学装备, 2019, 16(4): 95-98. doi: 10.3969/J.ISSN.1672-8270.2019.04.026 LI J, LIU R, CHEN B Q. Effects of inspiratory muscle training with heavy load of deep breath trainer on lung function and exercise endurance of patients with COPD at stable phase[J]. China Medical Equipment, 2019, 16(4): 95-98. doi: 10.3969/J.ISSN.1672-8270.2019.04.026
[10]	张平, 杨峰, 李寅环, 等. 呼吸训练器与缩唇呼气对AECOPD患者排痰效果的对比研究[J]. 国际呼吸杂志, 2020, 40(5): 349-350, 354. doi: 10.3760/cma.j.issn.1673-436X.2020.05.005 ZHANG P, YANG F, LI Y H, et al. A comparative study of the expectoration effect by breath training device and pursed lip breathing in patients with AECOPD[J]. International Journal of Respiration, 2020, 40(5): 349-350, 354. doi: 10.3760/cma.j.issn.1673-436X.2020.05.005
[11]	严娴婷, 黄勍栋, 唐婷玉, 等. 血清炎症因子和肺功能与OSAHS患者病情程度的相关性研究[J]. 中华全科医学, 2021, 19(6): 947-949. doi: 10.16766/j.cnki.issn.1674-4152.001957 YAN X T, HUANG Q D, TANG T Y, et al. Correlation of serum inflammatory factors and pulmonary function with the severity of OSAHS[J]. Chinese Journal of General Practice, 2021, 19(6): 947-949. doi: 10.16766/j.cnki.issn.1674-4152.001957
[12]	尹正录, 孟兆祥, 王继兵, 等. 肺康复对慢性阻塞性肺疾病稳定期患者BODE指数和血清炎症因子的影响[J/CD]. 中华临床医师杂志(电子版), 2019, 13(7): 521-526. YIN Z L, MENG Z X, WANG J B, et al. Effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with stable chronic obstructive pulmonary disease[J/CD]. Chinese Journal of Clinicians (Electronic Edition), 2019, 13(7): 521-526.
[13]	VIEIRA FABIOLA C O S, PEREIRA D S, COSTA T B, et al. Effects of a long term pulmonary rehabilitation program on functional capacity and inflammatory profile of older patients with COPD[J]. J Cardiopulm Rehabil Prev, 2018, 38(5): E12-E15. doi: 10.1097/HCR.0000000000000303
[14]	SZUCS B, SZUCS C, PETREKANITS M, et al. Molecular characteristics and treatment of endothelial dysfunction in patients with COPD: a review article[J]. Int J Mol Sci, 2019, 20(18): 4329. doi: 10.3390/ijms20184329
[15]	方英, 方群, 王世强, 等. 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[J]. 中华全科医学, 2021, 19(10): 1680-1684. doi: 10.16766/j.cnki.issn.1674-4152.002141 FANG Y, FANG Q, WANG S Q, et al. Efficacy evaluation of simplified Six-word formula combined with extracorporeal phrenic pace-making in pulmonary rehabilitation of patients with COPD stable period[J]. Chinese Journal of General Practice, 2021, 19(10): 1680-1684. doi: 10.16766/j.cnki.issn.1674-4152.002141
[16]	赵丽丽, 王青霞. 止咳平喘十二味合剂联合乌苯美司胶囊对急性加重期慢性阻塞性肺疾病病人氧合指数、免疫失衡及炎性因子的影响[J]. 安徽医药, 2021, 25(12): 2519-2522. doi: 10.3969/j.issn.1009-6469.2021.12.043 ZHAO L L, WANG Q X. Effects of Zhike Pingchuan twelve mixture combined with ubenimex capsule on oxygenation index, immune imbalance and inflammatory factors in patients with COPD[J]. Anhui Medical and Pharmaceutical Journal, 2021, 25(12): 2519-2522. doi: 10.3969/j.issn.1009-6469.2021.12.043