摘要
我们调查了慢性阻塞性肺疾病(COPD)患者在家中进行12周的康复治疗是否对乳酸生成、代谢气体交换数据、吸气肌负荷和最大自行车力计测试时的呼吸困难有有益的影响。第二个目的是评估呼吸困难的变化是否与吸气肌负荷的变化有关。43例严重气道阻塞的COPD患者被纳入研究:平均1秒用力呼气量(FEV1) 1.3 +/- 0.4 L(44%预测),平均FEV1/吸气肺活量(IVC) 37 +/- 8%。28名病人开始接受康复治疗,15名病人没有接受康复治疗。康复在家中进行;病人由一名全科医生、一名物理治疗师和一名护士监督。通过6分钟步行距离测试(6MWD)和最大工作量(Wmax)测量运动耐量,同时进行递增症状受限循环功计测试。用张力时间指数(TTI)评估Wmax时吸气肌负荷,用Borg量表评估Wmax时呼吸困难。12周后,与对照组相比,康复组6MWD(从438到447 m)和Wmax(从70到78 W)显著增加。康复组在最大负荷时的耗氧量(V1O2)(从1.0升到1.1升)、乳酸水平(从3.7升到3.1 mEq.L(-1))、呼吸困难(从6.0升到4.5)和TTI(从0.10升到0.08)均有显著改善。 The reduction in TTI was not significantly correlated with the fall in dyspnoea, as assessed by the Borg scale. We conclude that 12 weeks of rehabilitation at home in COPD patients increases symptom-limited V1O2 in combination with an increased Wmax. At this significantly higher Wmax, there was a reduction in dyspnoea, lactate level and inspiratory muscle workload. The reduction in dyspnoea was not related to a decreased inspiratory muscle workload. This study shows that rehabilitation at home can produce beneficial physiological improvements during exercise in patients with chronic obstructive pulmonary disease.