营养支持辅助运动训练在治疗慢性阻塞性肺疾病中的临床应用研究
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摘要
目的探讨营养支持辅助运动训练在治疗慢性阻塞性肺疾病(COPD)中的临床价值。方法选择2013年1月至2014年12月来该院接受治疗的COPD患者80例,分为营养支持辅助运动训练组(试验组,n=40)和运动训练组(对照组,n=40)。两组患者均给予吸氧治疗,同时控制感染,给予化痰、平喘解痉治疗,维持水电解质及酸碱平衡,指导患者合理饮食。试验组在此基础上给予营养支持辅助运动训练;对照组给予同样的运动训练,持续1年。比较两组患者在治疗前及治疗后1年基础资料、肺功能指标、肺气肿指标、血气指标、上臂肌围、肱三头肌皮皱厚度、改良版英国医学研究会呼吸困难量表(MMRC)评分、圣乔治呼吸问卷(SGRQ)评分、6min步行试验、共病指数评分等方面的差异,并比较两组患者治疗后临床总有效率、不良反应发生率方面的差异。结果两组患者治疗前在肺功能指标、肺气肿指标、血气指标、上臂肌围、肱三头肌皮皱厚度、MMRC评分、SGRQ评分、6min步行试验、共病指数评分方面差异无统计学意义(P>0.05)。两组患者治疗后,试验组在第1秒用力呼气容积(FEV1)、FEV1占预计值百分比、用力肺活量(FVC)、肺总量(TLC)占预计值百分比、壁面积百分比、平均肺密度比、PaO2、6min步行试验方面显著高于对照组(P<0.05),在MMRC评分、SGRQ评分方面显著低于对照组(P<0.05)。治疗后试验组临床总有效率为95.0%,显著高于对照组临床总有效率(77.5%),差异有统计学意义(P<0.05)。治疗后试验组不良反应发生率为7.5%,低于对照组不良反应发生率(12.5%),但差异无统计学意义(P>0.05)。结论营养支持辅助运动训练相比单纯运动训练可显著改善COPD患者肺功能及肺气肿指标,临床疗效明确,不良反应发生率低。
Objective To investigate the clinical value of nutritional support and exercise training in the treatment of chronic obstructive pulmonary disease(COPD).Methods A total of 80 patients with COPD in our hospital from Jan 2013 to Dec 2014 were selected as study subjects.They were randomly divided into two groups:nutrition support training group(test group,n=40)and exercise training group(control group,n=40).Two groups of patients were given oxygen treatment,while controlling infection,expectorant,antiasthmatic,antispasmodic treatment,maintenance of water,electrolyte and acid-base balance,and guide patients reasonable diet.The experimental group was given nutritional support and assisted exercise training.The control group received the same exercise training for 1 years.The difference of the basic data,pulmonary function,pulmonary emphysema index,blood gas index,arm muscle circumference,triceps skinfold,MMRC score,SGRQ score,6 min walk test,comorbidity index score before treatment and after 1 years were compared,the difference of the total effective rate and adverse reaction rate between the two groups after treatment were compared.Results The patients of two groups in pulmonary function index,pulmonary emphysema index,blood gas index,arm muscle circumference,triceps skinfold,MMRC score,SGRQ score,6 min walk test,comorbidity index score,the difference were not significant(P>0.05),two groups of patients after treatment in the experimental group,FEV1,FEV1 percentage of predicted value,FVC,TLC percentage of predicted value,percentage of wall area,the average lung density ratio,PaO2 and 6 min walk test were significantly higher than the control group(P<0.05),the scores of MMRC and SGRQ were significantly lower than those of the control group(P<0.05).After treatment,the total effective rate of the experimental group was 95.0%,which was significantly higher than that of the control group,and the total effective rate was 77.5%(P<0.05).The incidence of adverse reactions in the experimental group was 7.5%,which was lower than that of the control group,and the incidence of adverse reactions was 12.5%,the difference was not statistically significant(P>0.05).Conclusion Compared with exercise training,the nutrition support exercise training can significantly improve the pulmonary function and emphysema index of COPD patients.The clinical efficacy is clear,and the incidence of adverse reactions is low.
Objective To investigate the clinical value of nutritional support and exercise training in the treatment of chronic obstructive pulmonary disease(COPD).Methods A total of 80 patients with COPD in our hospital from Jan 2013 to Dec 2014 were selected as study subjects.They were randomly divided into two groups:nutrition support training group(test group,n=40)and exercise training group(control group,n=40).Two groups of patients were given oxygen treatment,while controlling infection,expectorant,antiasthmatic,antispasmodic treatment,maintenance of water,electrolyte and acid-base balance,and guide patients reasonable diet.The experimental group was given nutritional support and assisted exercise training.The control group received the same exercise training for 1 years.The difference of the basic data,pulmonary function,pulmonary emphysema index,blood gas index,arm muscle circumference,triceps skinfold,MMRC score,SGRQ score,6 min walk test,comorbidity index score before treatment and after 1 years were compared,the difference of the total effective rate and adverse reaction rate between the two groups after treatment were compared.Results The patients of two groups in pulmonary function index,pulmonary emphysema index,blood gas index,arm muscle circumference,triceps skinfold,MMRC score,SGRQ score,6 min walk test,comorbidity index score,the difference were not significant(P>0.05),two groups of patients after treatment in the experimental group,FEV1,FEV1 percentage of predicted value,FVC,TLC percentage of predicted value,percentage of wall area,the average lung density ratio,PaO2 and 6 min walk test were significantly higher than the control group(P<0.05),the scores of MMRC and SGRQ were significantly lower than those of the control group(P<0.05).After treatment,the total effective rate of the experimental group was 95.0%,which was significantly higher than that of the control group,and the total effective rate was 77.5%(P<0.05).The incidence of adverse reactions in the experimental group was 7.5%,which was lower than that of the control group,and the incidence of adverse reactions was 12.5%,the difference was not statistically significant(P>0.05).Conclusion Compared with exercise training,the nutrition support exercise training can significantly improve the pulmonary function and emphysema index of COPD patients.The clinical efficacy is clear,and the incidence of adverse reactions is low.
引文
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[13]李辉,杨莹.肠内营养支持治疗在慢性阻塞性肺疾病并发呼吸衰竭病人的疗效观察[J].肠外与肠内营养,2015,22(3):164-167.
[14]李永强.呼吸运动锻炼联合营养支持治疗慢性阻塞性肺疾病的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(3):107-110.
[15]SONG C,SHIEH C H,WU Y S,et al.The role of omega-3polyunsaturated fatty acids eicosapentaenoic and docosahexaenoic acids in the treatment of major depression and Alzheimer′s disease:Acting separately or synergistically?[J].Prog Lipid Res,2016,62(1):41-54.
[16]CARSON E L,POURSHAHIDI L K,HILL T R,et al.Vitamin D,muscle function,and cardiorespiratory fitness in adolescents from the young hearts study[J].J Clin Endocrinol Metab,2015,100(12):4621-4628.
[17]STOCK M S,YOUNG J C,GOLDING L A,et al.The effects of adding leucine to pre and postexercise carbohydrate beverages on acute muscle recovery from resistance training[J].J Strength Cond Res,2010,24(8):2211-2219.
[18]VAN DE BOOL C,RUTTEN E P,VAN HELVOORT AA,et al.A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD[J].J Cachexia Sarcopenia Muscle,2017,8(5):748-758.
[2]PASSEY S L,HANSEN M J,BOZINOVSKI S,et al.E-merging therapies for the treatment of skeletal muscle wasting in chronic obstructive pulmonary disease[J].Pharmacol Ther,2016,166(1):56-70.
[3]FERREIRA I M,BROOKS D,LACASSE Y,et al.Nutritional supplementation for stable chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2005,12(2):CD000998.
[4]中华人民共和国卫生部.慢性阻塞性肺疾病诊断标准[J].国际呼吸杂志,2011,31(1):1-2.
[5]NATORI H,KAWAYAMA T,SUETOMO M,et al.E-valuation of the modified medical research council dyspnea scale for predicting hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease[J].Intern Med,2016,55(1):15-24.
[6]FERRER M,JONES P W.The St.George′s respiratory questionnaire[M].Springer Netherlands,2014.
[7]周海霞,唐永江,王岚,等.肺栓塞远期死亡危险因素及Charlson合并症指数的预测价值[J].中华医学杂志,2016,96(4):273-276.
[8]单敏捷.N-乙酰半胱氨酸辅助治疗慢性阻塞性肺疾病急性加重期的疗效分析[J/CD].中华肺部疾病杂志(电子版),2016,9(2):178-181.
[9]MANNINO D M,BUIST A S.Global burden of COPD:risk factors,prevalence,and future trends[J].Lancet,2007,370(9589):765-773.
[10]ALIBAKHSHI E,SHIRVANI H.NUTRITION review article nutritional status in patients with chronic obstruction pulmonary disease(COPD)-Review article[J].Nutr J,2015,2(1):267-274.
[11]CINDY NG L W,MACKNEY J,JENKINS S,et al.Does exercise training change physical activity in People with COPD?A systematic review and meta-analysis[J].Chron Respir Dis,2012,9(1):17-26.
[12]GAO Y L,ZHAI X L,LI K,et al.Asthma COPD overlap syndrome on CT densitometry:a distinct phenotype from COPD[J].COPD,2016,13(4):471-476.
[13]李辉,杨莹.肠内营养支持治疗在慢性阻塞性肺疾病并发呼吸衰竭病人的疗效观察[J].肠外与肠内营养,2015,22(3):164-167.
[14]李永强.呼吸运动锻炼联合营养支持治疗慢性阻塞性肺疾病的临床疗效观察[J].实用心脑肺血管病杂志,2016,24(3):107-110.
[15]SONG C,SHIEH C H,WU Y S,et al.The role of omega-3polyunsaturated fatty acids eicosapentaenoic and docosahexaenoic acids in the treatment of major depression and Alzheimer′s disease:Acting separately or synergistically?[J].Prog Lipid Res,2016,62(1):41-54.
[16]CARSON E L,POURSHAHIDI L K,HILL T R,et al.Vitamin D,muscle function,and cardiorespiratory fitness in adolescents from the young hearts study[J].J Clin Endocrinol Metab,2015,100(12):4621-4628.
[17]STOCK M S,YOUNG J C,GOLDING L A,et al.The effects of adding leucine to pre and postexercise carbohydrate beverages on acute muscle recovery from resistance training[J].J Strength Cond Res,2010,24(8):2211-2219.
[18]VAN DE BOOL C,RUTTEN E P,VAN HELVOORT AA,et al.A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD[J].J Cachexia Sarcopenia Muscle,2017,8(5):748-758.