| 摘要: | 前言:慢性阻塞性肺病(COPD)是一種呼吸道長期發炎導致無法恢復之呼吸道疾病，使得氣體無法通暢地進出呼吸道，此類患者常有小氣道塌陷，氣體聚積肺部，導致肺過度擴張、橫膈移動受限等問題。COPD病患在運動時更易有動態性肺過度擴張，壓迫橫膈肌擺動，喘的感覺也更加惡化，造成運動能力受阻，進而降低生活品質，此外，COPD有許多共病並存，表現出交感神經活躍、全身處於低度發炎情況，因此本研究將探討COPD患者接受呼吸肌訓練之成效。
研究方法:本實驗為前瞻性病例對照研究，採隨機分派，分為居家肺部復原無呼吸肌訓練組(Non-RMT)及居家肺部復原合併呼吸肌訓練組(RMT)，於臺北醫學大學附設醫院取樣，依COPD指引篩選中至極重度患者為收案對象。
Non-RMT組依門診常規肺部復原運動，RMT組除常規肺部復原運動外，依照病患最大吸吐氣壓力之50%給予呼吸肌訓練。介入時間皆為期八週之居家訓練，並在介入前後評估肺功能、運動耐受力、喘的感受程度、生活品質、呼吸肌及四肢肌力、橫膈膜偏移振幅、心跳變異度及血液發炎程度等變化情況。
研究結果:本研究共收集23位個案，隨機分派為兩組進行居家肺部復原或合併呼吸肌訓練。研究結果顯示，經呼吸肌訓練可以顯著增加最大吸吐氣肌力，最大吸氣壓力由53.18±5.99 cmH2O增加至65.93±7.85 cmH2O，最大吐氣壓力絕對值由85.00±5.64 cmH2O增加至108.90±10.75 cmH2O；也顯著改善生活品質(包含CAT及SF-12)、六分鐘行走距離平均增加44.4±11.3 m，但在肺功能、橫膈膜偏移振幅、四肢肌力、心跳變異度及全身發炎程度則未見成效。
結論:本研究結果發現藉由呼吸肌訓練，可以增加呼吸肌力、運動耐受力、生活品質等。另外，我們也探索了另一條可信的超音波基準線來評估橫膈膜偏移振幅的依據。
Background: Chronic obstructive pulmonary disease (COPD) is a respiratory disease caused by long-term inflammation of the respiratory airway, such patients have small airway obstruction causing air accumulates in the lungs, leading to hyperventilation and diaphragm limitation. Patients with COPD are more likely to have dynamic hyperventilation during exercise, and compressing the diaphragmatic movement, then short of breath progress, resulting in impaired exercise tolerance and thus decrease the quality of life. In addition, COPD has many comorbidities, showing sympathetic nerves are active and low-grade inflammation. Therefore, this study will investigate the effects of respiratory muscle training in patients with COPD.
Methods: This is a prospective case-control study that was randomize assigned to the home-base pulmonary rehabilitation without respiratory muscle training (Non-RMT) and the home-base pulmonary rehabilitation with respiratory muscle training (RMT), those who met the inclusion criteria were sampled at Taipei Medical University Hospital. According to the COPD guidelines, patients with moderate to very severe cases were selected as subjects. The Non-RMT group following the routine home-base pulmonary rehabilitation, the RMT group was given respiratory muscle training with 50% maximum inspiratory and expiratory pressure (Pimax, Pemax) in addition to home-base pulmonary rehabilitation. Both group intervention period are all 8 weeks, and assessment of lung function, exercise tolerance, dyspnea sensation, quality of life, respiratory muscle power and limb muscle strength, diaphragm excursion, heart rate variability and blood inflammation analysis at baseline and 8 weeks.
Results: 23 cases were randomize assigned to Non-RMT or RMT group. The results showed that respiratory muscle power was increased by respiratory muscle training, the Pimax was 53.18±5.99 cmH2O to 65.93±7.85 cmH2O, and the Pemax increased from 85.00±5.64 cmH2O to 108.90±10.75 cmH2O. and also showed an improvement in quality of life (including CAT and SF-12) and delta six-minute walking distance was increase 44.43±11.29 m. However, in lung function, diaphragm excursion, limb muscle strength, heart rate variability and blood systemic inflammation were not effective.
Conclusion: According to this study, we find respiratory muscle power, exercise tolerance and quality of life can be strengthen by respiratory muscle training. In addition, we also explored another reliable reference line to evaluate diaphragm excursion. |
