| 摘要: | 背景：肺阻塞（Chronic obstructive pulmonary disease ，COPD）是全球第三大死因，在台灣估計40 歲以上成年人患病率為 6.1%。隨著疾病進展出現呼吸困難、咳嗽、咳痰、胸悶和疲勞。慢性發炎反應會誘發肺外的症狀如憂鬱症、肌肉減少症。肺復原可以改善慢性肺部疾病病人的呼吸困難、健康狀態和運動耐受性。而接受肺復原的的病人中約4-5成被發現合併運動引起的血氧飽和度下降（Exercise induced desaturation，EID）。EID的病患呼吸困難程度更高、肌肉力量減少、日常活動受損、生活品質較差、六分鐘行走測試距離（Six-minutes walking distance， 6MWD）下降風險。本研究探討接受肺復原之COPD病人，結構性肺復原療程（Structured pulmonary rehabilitation，SPR）對改善COPD合併EID病人運動能力、功能性運動能力和健康相關生活品質之成效。
研究方法：回顧2017年至2020年期間某醫學中心肺復原室的COPD病人，分成EID和non-EID兩組，依據有無接受肺復原療程分成SPR和常規組（Routine care，RC）。RC每年接受肺復原評估。SPR為期八週，每週一次到醫院復原，內容包括：有氧運動、上下肢肌力阻力訓練和衛教。療程結束後每個月追蹤1次，共2次。並持續每年追蹤病患，共2年。
研究結果：肺復原介入的兩組在6MWD都達到顯著增加，SPR non-EID從4週到16W，增加的距離均達到最小臨床差異，並且持續增加到追蹤1年並且達到統計上差異。SPR EID 6MWD從4週到追蹤1年持續增加達到統計上差異，並且從8週開始增加的距離均達到MICD，在追蹤2年時才下降。SPR EID在L-SpO2從4週到追蹤2年持續獲得改善，從評估期（M =83.68 m± 4.10）到4週改變差值（B =1.50 %，p <.01）進步1.5%，從評估期到8週改變差值（B =2.56 %，p <.001）進步2.5%，從評估期到16週改變差值（3.07 %，p <.001）進步3%。SPR EID不論在休息時和六分鐘行走測試後自覺呼吸困難均獲得改善，由尤其是運動測試後的改善持續到追蹤2年並且達到統計上差異。SPR non-EID組在四公尺步行速度獲得顯著改善，並在統計上達顯著差異； SPR EID在5次重複做到站些微改善。在生活品質的改變差值雖未達統計上差異，但都有獲得緩慢改善。常規照護組部分：RC non-EID組在L-SpO2從評估到追蹤1年（B = -0.61 %，p <.01）和評估到追蹤2年（B = -0.63 %，p <.01）持續下降。RC EID組在L-SpO2從評估到追蹤年2年是獲得改善的。改變差值在追蹤1年（B = 0.66 %，p =.483）和追蹤2年（B = 3.10 %，p <.05）。RC non-EID組在休息時呼吸困難程度從評估到追蹤年2年（B = 0.25，p <.05）是增加的。
結論：肺復原療程對COPD是ㄧ項重要的非藥物性治療，我們的研究結果肺復原療程對COPD合併EID的效益中，6MWD和L-SpO2獲得顯著改善。應鼓勵定期接受肺復原療程並長期追蹤，特別對COPD合併EID。
Background: COPD is the third leading cause of death globally, and in Taiwan, the estimated prevalence among adults aged 40 and above is 6.1%. As the disease progresses, individuals may experience symptoms such as difficulty breathing, cough, sputum production, chest tightness, and fatigue. Chronic inflammation can induce extrapulmonary symptoms, including depression and muscle wasting. Pulmonary rehabilitation has been shown to improve respiratory difficulties, overall health, and exercise tolerance in patients with chronic lung diseases. Approximately 40-50% of patients undergoing pulmonary rehabilitation are found to have Exercise-Induced Desaturation (EID), characterized by a drop in blood oxygen saturation during exercise. Patients with EID often exhibit higher levels of respiratory difficulties, reduced muscle strength, impaired daily activities, poorer quality of life, and an increased risk of decreased walking distance in the six-minute walk test.
Aim: To investigate the efficacy of Structured Pulmonary Rehabilitation (SPR) in improving exercise capacity, functional mobility, and health-related quality of life in COPD patients with coexisting Exercise-Induced Desaturation (EID) undergoing pulmonary rehabilitation.
Methods: A retrospective analysis was conducted on COPD patients from a medical center's pulmonary rehabilitation facility between 2017 and 2020. Patients were categorized into two groups: those with Exercise-Induced Desaturation (EID) and those without (non-EID). Based on whether they received pulmonary rehabilitation, they were further divided into Structured Pulmonary Rehabilitation (SPR) group and Routine Care (RC) group. The RC group underwent annual pulmonary rehabilitation assessments. The SPR program spanned eight weeks, with weekly sessions at the hospital, including aerobic exercise, upper and lower limb muscle resistance training, and educational components. After the completion of the program, follow-up sessions were conducted monthly for the first two months and continued with yearly follow-ups over a two-year period.
Results: Both intervention groups in pulmonary rehabilitation demonstrated a significant increase in 6-Minute Walk Distance (6MWD). The SPR non-EID group showed a sustained increase from 4 weeks to 16 weeks, with distances reaching the Minimal Important Clinical Difference (MICD), and this improvement continued throughout the two-year follow-up. The SPR EID group exhibited a continuous increase in 6MWD from 4 weeks to the first year, reaching MICD from 8 weeks onwards, and a decrease was observed only at the 2-year follow-up. In terms of L-SpO2, the SPR EID group showed consistent improvement from 4 weeks to the 2-year follow-up. The change in values from the assessment period (M = 83.68 ± 4.10) to 4 weeks (difference: 1.50, p < .01) indicated a 1.5% improvement. The change from the assessment period to 8 weeks (difference: 2.56, p < .001) demonstrated a 2.5% improvement, and from the assessment period to 16 weeks (difference: 3.07, p < .001) reflected a 3% improvement. SPR EID group reported improved perceived respiratory difficulty both at rest and after the six-minute walk test. This improvement, especially post-exercise, persisted up to the 2-year follow-up and reached statistical significance. The SPR non-EID group exhibited significant improvement in 4-Meter Gait Speed (4MGS), reaching statistical significance. The SPR EID group showed slight improvement in 5-Times Sit-to-Stand (5STS). Although the change in EQ-5D-5L did not reach statistical significance, there was a gradual improvement observed over time. In the conventional care group: RC non-EID group exhibited a continuous decline in L-SpO2 from baseline to the first year (B = -0.61, p < 0.01) and baseline to the second year (B = -0.63, p < 0.01) of follow-up. RC EID group showed improvement in L-SpO2 from baseline to the 2-year follow-up, with change values of 0.66 (p = 0.483) at the first year and 3.10 (p < 0.05) at the second year. RC non-EID group experienced an increase in breathlessness at rest from baseline to the 2-year follow-up (B = 0.25, p < 0.05).
Discussion: Pulmonary rehabilitation is a crucial non-pharmacological intervention for COPD, and regular participation in such programs is encouraged, particularly for COPD patients with Exercise-Induced Desaturation (EID). |
