间质性肺疾病患者肺康复治疗效果的多中心研究

摘要

Objective To observe the effects of pulmonary rehabilitation on the pulmonary function,quality of life and psychological state of patients with interstitial lung disease(ILD).Methods The enrolled participants for this prospective multicenter controlled study were 248 cases of ILD admitted in more than 10 hospitals in Shanghai Yangpu District from January to December 2015.They were randomized to the control group (n=124) receiving the conventional drug therapy,and the intervention group (n=124) receiving the conventional drug therapy combined with pulmonary rehabilitation treatment.One year after treatment,all the patients measured the markers of pulmonary function,vital capacity(VC),forced expiratory volume in the first second (FEV1),total lung capacity (TLC),and carbon monoxide diffusion capacity (DLCO),performing six-minute walk test (6MWT) reflecting the exercise capacity,completed Medical Research Council Scale(MRC),St.George′s Respiratory Questionnaire (SGRQ),and Hospital Anxiety and Depression Scale (HADS).And the results of the two groups were compared.Results Two groups had no significant differences in sex distribution,age,course of ILD and oxygen saturation of blood (SaO2) (P>0.05).Before treatment,the results of VC,FEV1,TLC and DLCO,6MWT and MRC dyspnea scores were similar in both groups(P>0.05),and they were still similar after treatment(P>0.05) except the results of 6MWT,which were longer in the intervention group (P<0.05).Before treatment,the SGRQ scores for symptoms,mobility and the impact on life and the total score in the intervention group were not different from those in the control group(P>0.05),but after treatment,they were significantly lower in the intervention group than in the control group(P<0.05).Lower HADS scores for anxiety and depression were found in the intervention group than in the control group after treatment (P<0.05),while they showed no differences between the two groups before treatment (P>0.05).Conclusion Pulmonary rehabilitation in ILD can significantly improve the quality of life,psychological state and exercise capacity except the pulmonary function.%目的 探讨肺康复治疗对间质性肺疾病(ILD)患者肺功能、生活质量和心理状态的影响.方法 选取2015年1-12月上海市杨浦区一、二、三级医院等10余家医疗单位收治的ILD患者248例进行前瞻性多中心对照研究,按照随机数字表法分为对照组(n=124)和干预组(n=124).对照组患者仅接受常规药物治疗,干预组在对照组药物治疗的基础上接受肺康复治疗.1年后比较两组患者肺功能〔肺活量(VC)、第1秒用力呼气末容积(FEV1)、肺总量(TLC)及一氧化碳弥散量(DLCO)〕、运动能力〔6 min步行试验(6MWT)步行距离〕、呼吸困难程度〔医学研究会呼吸困难量表(MRC)评分〕、生活质量〔圣乔治呼吸问卷(SGRQ)评分〕及焦虑抑郁状态〔医院焦虑抑郁量表(HADS)评分〕等指标.结果 两组患者的性别、年龄、病程、血氧饱和度(SaO2)比较,差异无统计学意义(P>0.05).两组患者治疗前肺功能各项指标(包括VC、FEV1、TLC、DLCO)、6MWT步行距离、MRC评分比较,差异均无统计学意义(P>0.05);治疗后VC、FEV1、TLC、DLCO、MRC评分比较,差异无统计学意义(P>0.05),干预组6MWT步行距离长于对照组,差异有统计学意义(P<0.05).两组患者治疗前SGRQ临床症状、活动能力、疾病对日常生活的影响各项评分及总分比较,差异均无统计学意义(P>0.05);治疗后干预组评分低于对照组,差异均有统计学意义(P<0.05).两组患者治疗前HADS焦虑和抑郁评分比较,差异均无统计学意义(P>0.05);治疗后干预组评分较对照组降低,差异均有统计学意义(P<0.05).结论 肺康复治疗可有效改善患者生活质量和心理健康状况,提高患者的运动能力,但在改善肺功能方面效果并不显著.