本文選題：慢性阻塞性肺疾病 + 呼吸肌疲勞��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[背景]肺康復(fù)是目前COPD穩(wěn)定期患者治療的一個(gè)重要手段,其中呼吸肌鍛煉是肺康復(fù)的重要組成部分。吸氣肌鍛煉已被證實(shí)可以提高COPD患者的呼吸肌肉功能,緩解COPD患者呼吸困難程度,但是吸氣肌聯(lián)合呼氣肌鍛煉的康復(fù)效果目前仍存在較多爭議。采用閾值負(fù)荷呼吸肌鍛煉裝置可以根據(jù)患者的呼吸肌功能準(zhǔn)確調(diào)節(jié)鍛煉負(fù)荷,目前已得到廣泛應(yīng)用。國內(nèi)外有關(guān)呼吸肌聯(lián)合鍛煉通常采用吸氣肌和呼氣肌分別進(jìn)行鍛煉的方式。國內(nèi)“水封式”閾值負(fù)荷呼吸肌鍛煉裝置可以實(shí)現(xiàn)在同一呼吸周期內(nèi)完成吸氣肌和呼氣肌的聯(lián)合鍛煉,但其存在裝置體積較大、不易攜帶、可調(diào)節(jié)壓力負(fù)荷范圍小等缺陷。本研究在其可持續(xù)鍛煉的基礎(chǔ)上進(jìn)行改良,設(shè)計(jì)并構(gòu)造一種新型的體積較小、方便攜帶、可調(diào)閾值負(fù)荷更大的呼吸肌聯(lián)合鍛煉裝置。[目的]本研究擬比較吸氣肌鍛煉與兩種不同方式呼吸肌聯(lián)合鍛煉的COPD患者肺康復(fù)效果,探討吸氣肌和呼氣肌聯(lián)合鍛煉與單一吸氣肌鍛煉相比是否能帶來額外的獲益。本研究擬設(shè)計(jì)并構(gòu)造一種新型的、可實(shí)現(xiàn)吸呼相持續(xù)進(jìn)行呼吸肌鍛煉的閾值負(fù)荷鍛煉器,并比較使用該新型鍛煉器進(jìn)行呼吸肌聯(lián)合鍛煉與傳統(tǒng)的分解式聯(lián)合鍛煉及單純吸氣肌鍛煉模式對(duì)于COPD患者的肺康復(fù)效果是否存在差異。[方法]本研究按照納入及排除標(biāo)準(zhǔn)收集南方醫(yī)科大學(xué)珠江醫(yī)院呼吸內(nèi)科門診COPD穩(wěn)定期患者95例,隨機(jī)分成4組:對(duì)照組(the control group)、單一吸氣肌鍛煉組(inspiratory muscle training group,IMT)、完整吸呼相呼吸肌聯(lián)合鍛煉組(concurrent inspiratory and expiratory muscle training group,CRMT)、分解吸呼相呼吸肌聯(lián)合鍛煉組(separated inspiratory and expiratory muscle training group,SRMT),對(duì)照組不參加任何的呼吸肌鍛煉,IMT、CRMT、SRMT三組分別進(jìn)行為期8周的不同方案的呼吸肌鍛煉。鍛煉前后分別測試COPD肺康復(fù)患者的靜態(tài)肺功能、最大吸氣壓(massive inspiratory pressure,MIP)、最大呼氣壓(massive expiratory pressure,MEP)、呼吸困難癥狀評(píng)分(mMRC score)、6分鐘步行試驗(yàn)距離(6-min walking test distance,6MWD)、生活質(zhì)量評(píng)分(St.George's Respiratory Questionnaire,SGRQ)和抑郁、焦慮評(píng)分(Hospital depression and anxiety scale,HAD),比較使用改良的閾值負(fù)荷鍛煉器與傳統(tǒng)的分解式聯(lián)合鍛煉和單純的吸氣肌鍛煉的康復(fù)效果。[結(jié)果]構(gòu)造了一種新型改良的閾值負(fù)荷的呼吸肌鍛煉器,可以實(shí)現(xiàn)在同一個(gè)完整呼吸周期連續(xù)進(jìn)行吸氣肌鍛煉和呼氣肌鍛煉。IMT組的脫落率為8.70%,CRMT組的脫落率為12.50%,SRMT組的脫落率為 18.52%。與對(duì)照組相比,IMT、CRMT、SRMT三組肺康復(fù)鍛煉前后各組靜態(tài)肺功能指標(biāo)用力肺活量(FVC)、第一秒用力呼氣容積(FEV1)、第一秒用力呼氣容積占預(yù)計(jì)值的百分比(FEV1%pred)及6MWD的差異均無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。IMT組、CRMT組、SRMT組的MIP鍛煉后較鍛煉前分別提高9.791±6.870cmH_2O、9.938±6.987cmH_2O、8.073±6.692cmH_2O(P 均0.05),三組的改善幅度無明顯差異(P0.05),但顯著高于對(duì)照組(P0.05,對(duì)照組的改善幅度為1.928±4.429)。IMT、CRMT、SRMT三組的MEP鍛煉后較鍛煉前分別提高4.276±4.067 cmH20、9.243±8.404 cmH20、7.096±7.954 cmH20(P均0.05)。除 IMT 組外,CRMT 和SRMT兩組的MEP的改善幅度顯著高于對(duì)照組(P=0.008和P=0.036),但兩組間無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。IMT、CRMT、SRMT三組的mMRC評(píng)分鍛煉后較鍛煉前分別提高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),三組間無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。IMT、CRMT、SRMT三組的SGRQ評(píng)分鍛煉后較鍛煉前分別下降3.191±1.778、4.000±2.074、2.636±2.752(P均0.05),三組間無明顯統(tǒng)計(jì)學(xué)差異(P0.05),但改善幅度顯著高于對(duì)照組(P均0.05,對(duì)照組下降幅度為0.350±2.739)。IMT、CRMT、SRMT三組的CAT評(píng)分鍛煉后較鍛煉前分別下降2.238±2.700、2.714±2.306、1.818±1.622(P均0.05),三組間無明顯統(tǒng)計(jì)學(xué)差異(P0.05),改善幅度顯著高于對(duì)照組(P均0.05,對(duì)照組下降幅度為0.250±2.049)。各組間肺康復(fù)鍛煉前后BODE指數(shù)、抑郁、焦慮評(píng)分鍛煉前后的差值無統(tǒng)計(jì)學(xué)意義(P0.05)。IMT組吸氣肌肌力低下的患者M(jìn)IP的改善幅度優(yōu)于吸氣肌肌力正常的患者(P0.05),SRMT組吸氣肌肌力低下的患者M(jìn)IP、MEP的改善幅度優(yōu)于吸氣肌肌力正常的患者(P0.05)。CRMT組吸氣肌肌力低下的患者M(jìn)IP、MEP的改善程度與吸氣肌肌力正常的患者相比無明顯統(tǒng)計(jì)學(xué)差異(P均0.05)。IMT、CRMT、SRMT三組吸氣肌肌力低下的患者肺功能、mMRC評(píng)分、6WMD、SGRQ評(píng)分、HAD評(píng)分、BODE評(píng)分的改善程度與吸氣肌正常的患者相比無明顯差異(P0.05)。[結(jié)論]使用新型改良的呼吸肌聯(lián)合鍛煉器(CRMT)可顯著提高M(jìn)IP、MEP,mMRC評(píng)分、SGRQ評(píng)分、CAT評(píng)分,與SRMT的康復(fù)效果無顯著差異,但是改良的呼吸肌聯(lián)合鍛煉器存在結(jié)構(gòu)完整、攜帶方便、患者依從性高等優(yōu)勢。兩種呼吸肌聯(lián)合鍛煉方案在改善MIP、mMRC評(píng)分、SGRQ評(píng)分、CAT評(píng)分與IMT組相比無明顯差異,但是在改善MEP上優(yōu)于IMT。IMT、CRMT、SRMT三組改善肺功能、6MWD、BODE指數(shù)、HAD評(píng)分上效果不顯著。IMT組、CRMT組、SRMT組吸氣肌肌力低下的患者在進(jìn)行呼吸肌鍛煉后與吸氣肌肌力正常的患者相比:IMT組的MIP改善更顯著,SRMT組的MIP和MEP改善更顯著,兩組其余指標(biāo)改善不明顯,CRMT組各指標(biāo)的改善幅度無明顯差異。在后期改良設(shè)計(jì)中,在不同的呼吸肌閾值負(fù)荷鍛煉器上安裝數(shù)據(jù)采集管理裝置,實(shí)時(shí)記錄患者的鍛煉時(shí)間、頻率、強(qiáng)度,監(jiān)控患者的依從性和使用情況,精準(zhǔn)評(píng)估呼吸肌鍛煉的肺康復(fù)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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 杜佳;雷撼;胡蕓;吳怡;梁永;;SGRQ、CAT和CCQ問卷在COPD患者生活質(zhì)量中的評(píng)估價(jià)值比較[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2015年12期

，

本文編號(hào)：1912926