慢性阻塞性肺疾病急性加重期患者肺康复分级方案的构建与应用

doi:10.3761/j.issn.0254-1769.2024.07.001

摘要/Abstract

摘要：

目的构建COPD急性加重期患者肺康复分级方案并进行初步应用，为护理人员科学地实施肺康复提供参考。方法 2023年3月—10月，基于Triangle模型和循证方法构建肺康复分级方案初稿，通过2轮专家函询对条目进行修订，将构建的肺康复分级方案在10例COPD急性加重期患者中进行初步应用。结果 2轮专家函询问卷有效回收率均为100%，专家权威系数分别为0.857、0.863，变异系数分别为0~0.285、0.052~0.244，肯德尔和谐系数分别为0.167、0.145（均P<0.001）。最终形成的方案包括4个一级指标，13个二级指标，25个三级指标。方案应用后患者6 min步行试验、改良版英国医学研究委员会呼吸困难问卷和COPD疾病评分较干预前均有所改善，差异具有统计学意义（均P<0.05）。结论该研究构建的COPD急性加重期患者肺康复分级方案具有较好的科学性和实用性，可为临床实施肺康复提供参考。

关键词: 肺疾病, 慢性阻塞性, 急性加重期, 运动康复, Triangle模型, 德尔菲法, 护理

Abstract:

Objective To construct and preliminarily apply a graded exercise rehabilitation program for patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD），and to provide a theoretical basis for the scientific implementation of exercise rehabilitation by medical staff. Methods Based on Triangle model and evidence-based method，the first draft of the graded exercise rehabilitation program was constructed，and the items were revised through 2 rounds of expert consultations from March to October，2023. The graded exercise rehabilitation program was preliminarily applied in 10 patients with AECOPD. Results The effective recovery rates of the 2 rounds of expert consultation questionnaires were 100%；the expert authority coefficients were 0.857 and 0.863；the coefficients of variation were 0-0.285 and 0.052-0.244；the Kendall’s harmony coefficients were 0.167 and 0.145，respectively（all P<0.001）. The final plan includes 4 first-level indicators，13 second-level indicators，and 25 third-level indicators. The scores of 6 min walking test，mMRC and CAT after exercise were improved compared with those before exercise，and the differences were statistically significant（all P<0.05）. Conclusion The graded exercise rehabilitation program for patients with AECOPD constructed in this study has good scientificity and practicability，which can provide references for clinical implementation of exercise rehabilitation.

Key words: Pulmonary Disease, Chronic Obstructive, Acute Exacerbation, Exercise Rehabilitation, Triangle Model, Delphi Method, Nursing Care

杨娜娜, 曾慧, 符丹丹, 王燕, 程传丽, 刘容, 罗露文. 慢性阻塞性肺疾病急性加重期患者肺康复分级方案的构建与应用[J]. 中华护理杂志, 2024, 59(7): 773-780.

YANG Nana, ZENG Hui, FU Dandan, WANG Yan, CHENG Chuanli, LIU Rong, LUO Luwen. Construction and application of a graded exercise rehabilitation program for patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2024, 59(7): 773-780.

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参考文献 35

[1]	Han MK, Quibrera PM, Carretta EE, et al. Frequency of exacerbations in patients with chronic obstructive pulmonary disease:an analysis of the SPIROMICS cohort[J]. Lancet Respir Med, 2017, 5(8):619-626. DOI URL
[2]	叶健铿, 蒙晓, 吴耀洲, 等. AECOPD患者住院直接经济负担影响因素分析及相关建议[J]. 中国药房, 2022, 33(12):1474-1478.
	Ye JK, Meng X, Wu YZ, et al. Analysis of influential factors of direct economic burden of AECOPD patients in hospital and related suggestions[J]. China Pharm, 2022, 33(12):1474-1478.
[3]	张义静, 李娟, 孙丽, 等. 慢性阻塞性肺疾病患者早期简易肺康复方案的构建及应用[J]. 中华护理杂志, 2020, 55(5):690-695. DOI URL
	Zhang YJ, Li J, Sun L, et al. Construction of an early simple pulmonary rehabilitation programme for patients with COPD and its evaluation of effectiveness[J]. Chin J Nurs, 2020, 55(5):690-695. DOI URL
[4]	谭春苗, 陈淼, 王小环, 等. 不同运动处方应用于慢性阻塞性肺疾病急性加重期患者的康复效果评价[J]. 军事护理, 2022, 39(12):22-25.
	Tan CM, Chen M, Wang XH, et al. Evaluation of rehabilitation effect of different exercise prescriptions in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Milit Nurs, 2022, 39(12):22-25.
[5]	Feachem RGA, Sekhri NK, White KL. Getting more for their dollar:a comparison of the NHS with California’s Kaiser Permanente[J]. BMJ, 2002, 324(7330):135-141. DOI URL
[6]	Global Initiative for Chronic Obstructive Lung Disease:global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease. (2023 report)[EB/OL].[2022-11-15]. https://goldcopd.org/2022-gold-reports-2/.
[7]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3):170-205.
	Chronic Obstructive Pulmonary Disease Group of Respiratory Disease Branch of Chinese Medical Association,Chronic Obstructive Pulmonary Disease Working Committee of Respiratory Physician Branch of Chinese Medical Association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease(revised version 2021)[J]. Chin J Tuberc Respir Dis, 2021, 44(3):170-205.
[8]	中国老年医学学会呼吸病学分会慢性阻塞性肺疾病学组. 中国老年慢性阻塞性肺疾病临床诊治实践指南[J]. 中华结核和呼吸杂志, 2020, 43(2):100-119.
	The Chronic Obstructive Pulmonary Disease Group of Respiratory Disease Branch of Chinese Geriatrics Society. Chinese practice guideline for clinical diagnosis and treatment of chronic obstructive pulmonary disease in the elderly[J]. Chin J Tuberc Respir Dis, 2020, 43(2):100-119.
[9]	Khan JH, Lababidi HMS, Al-Moamary MS, et al. The Saudi guidelines for the diagnosis and management of COPD[J]. Ann Tho-rac Med, 2014, 9(2):55-76.
[10]	Koninklijk Nederlands Genootschap voor Fysiotherapie. Chronic obstructive pulmonary disease Practice guidelines[J]. Dutch J Phy Ther, 2008, 118(2):1-66.
[11]	Guidelines International Network:Chronic obstructive pulmonary disease(2022REPORT)[EB/OL]. [2021-08-17]. https://guidelines.ebmportal.com/copd-nationale-versorgungsleitlinie-nvl.
[12]	Danish National Health Council. National clinical guideline for the rehabilitation of patients with chronic obstructive pulmonary disease[J]. Danish Heal Auth, 2018, 12(1):111-121.
[13]	Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement:key concepts and advances in pulmonary rehabilitation[J]. Am J Respir Crit Care Med, 2013, 188(8):e13-e64. DOI URL
[14]	宫玉翠, 陈洁雅, 李平东, 等. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志, 2020, 55(5):709-710. DOI URL
	Gong YC, Chen JY, Li PD, et al. Expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases[J]. Chin J Nurs, 2020, 55(5):709-710. DOI URL
[15]	武亮, 郭琪, 胡菱, 等. 中国呼吸重症康复治疗技术专家共识[J]. 中国老年保健医学, 2018, 16(5):3-11.
	Wu L, Guo Q, Hu L, et al. Expert consensus on rehabilitation treatment of severe respiratory diseases in China[J]. Chin J Geriatr Care, 2018, 16(5):3-11.
[16]	Zhang CC, Yu XD, Yu JC, et al. Effectiveness of physiotherapy techniques for rehabilitation after acute chronic obstructive pulmonary disease exacerbation:a meta-analysis[J]. Int J Clin Exp Med, 2018, 11(8):7572-7582.
[17]	Machado A, Matos Silva P, Afreixo V, et al. Design of pulmonary rehabilitation programmes during acute exacerbations of COPD:a systematic review and network meta-analysis[J]. Eur Respir Rev, 2020, 29(158):200039. DOI URL
[18]	Xiang GL, Wu QH, Wu X, et al. Non-invasive ventilation intervention during exercise training in individuals with chronic obstructive pulmonary disease:a systematic review and meta-analysis[J]. Ann Phys Rehabil Med, 2021, 64(6):101460. DOI URL
[19]	Moecke DP, Zhu K, Gill J, et al. Safety and efficacy of inpatient pulmonary rehabilitation for patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease:systematic review and meta-analyses[J]. Ann Am Thorac Soc, 2023, 20(2):307-319. DOI URL
[20]	Du YP, Lin J, Wang XX, et al. Early pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease:a meta-analysis of randomized controlled trials[J]. COPD, 2022, 19(1):69-80. DOI URL
[21]	Torres-Sánchez I, Valenza MC, Sáez-Roca G, et al. Results of a multimodal program during hospitalization in obese COPD exacerbated patients[J]. COPD, 2016, 13(1):19-25. DOI PMID
[22]	贾琳琳, 邢金燕, 刘梦丹. 早期肺康复在AECOPD伴呼吸衰竭患者中的应用效果[J]. 国际护理学杂志, 2016, 35(19):2673-2677.
	Jia LL, Xing JY, Liu MD. Effects of early pulmonary rehabilitation for AECOPD patients with respiratory failure[J]. Int J Nurs, 2016, 35(19):2673-2677.
[23]	黄斐斐, 陈丽华, 张雯, 等. 老年慢性阻塞性肺疾病急性加重住院患者开展早期肺康复干预的效果研究[J]. 中国全科医学, 2018, 21(32):4032-4036. DOI
	Huang FF, Chen LH, Zhang W, et al. Early pulmonary rehabilitation for elderly inpatients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin Gen Pract, 2018, 21(32):4032-4036.
[24]	Lu HY, Chen CF, Lee D, et al. Effects of early pulmonary rehabilitation on hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease:a systematic review and meta-analysis[J]. Int J Chronic Obstr Pulm Dis, 2023, 18:881-893.
[25]	刘卫庭, 姚宇. 早期肺康复对慢性阻塞性肺疾病急性加重期患者肺功能及运动耐力的影响[J]. 中华物理医学与康复杂志, 2019, 41(3):213-216.
	Liu WT, Yao Y. Effect of early lung rehabilitation on lung function and exercise endurance of patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Phys Med Rehabil, 2019, 41(3):213-216.
[26]	周小荣, 曾小娥, 张江平, 等. BODE分级方案用于慢性阻塞性肺疾病急性加重患者康复干预[J]. 护理学杂志, 2021, 36(12):79-83.
	Zhou XR, Zeng XE, Zhang JP, et al. Rehabilitation intervention based on the BODE index for patients with acute exacerbation of chronic obstructive pulmonary disease[J]. J Nurs Sci, 2021, 36(12):79-83.
[27]	李珊娜, 王秀华, 甘雨珠, 等. 对接受无创机械通气的急性加重期慢性阻塞性肺疾病患者进行肺康复治疗的效果探讨[J]. 当代医药论丛, 2020, 18(10):40-42.
	Li SN, Wang XH, Gan YZ, et al. Effect of pulmonary rehabilitation on weaning efficiency of patients with acute exacerbation of COPD undergoing noninvasive mechanical ventilation[J]. Contemp Med Symp, 2020, 18(10):40-42.
[28]	张钰, 刘元, 张文亮, 等. 短期肺康复程序对男性慢性阻塞性肺疾病急性加重期患者运动能力和生活质量的影响[J]. 中华物理医学与康复杂志, 2020, 42(2):146-151.
	Zhang Y, Liu Y, Zhang WL, et al. The effect of short-term pulmonary rehabilitation program on exercise capacity and quality of life in male patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Phys Med Rehabil, 2020, 42(2):146-151.
[29]	Lu HN, Liu N, Hu JY, et al. The effectiveness,safety and compliance of Zheng’s supine rehabilitation exercise as a rehabilitation programme among elderly patients with AECOPD[J]. Clin Respir J, 2020, 14(6):533-540. DOI URL
[30]	Güell-Rous MR, Morante-Vélez F, Flotats-Farré G, et al. Timing of pulmonary rehabilitation in readmitted patients with severe chronic obstructive pulmonary disease:a randomized clinical trial[J]. COPD, 2021, 18(1):26-34. DOI URL
[31]	Vitacca M, Kaymaz D, Lanini B, et al. Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support:a randomized controlled trial[J]. Respirology, 2018, 23(2):182-189.
[32]	何梅, 于素娥, 洪光朝, 等. 慢性阻塞性肺疾病急性加重期进行呼吸康复对健康相关生存质量变化的影响[J]. 中国康复医学杂志, 2018, 33(6):636-641.
	He M, Yu SE, Hong GC, et al. Effects of pulmonary rehabilitation on health-related quality of life for patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Rehabil Med, 2018, 33(6):636-641.
[33]	Koons B, Greenland JR, Diamond JM, et al. Pathobiology of frailty in lung disease[J]. Transl Res, 2020, 221:1-22. DOI PMID
[34]	王正珍. ACSM运动测试与运动处方指南[M]. 10版. 北京: 人民卫生出版社, 2019:12-37.
	Wang ZZ. ACSM exercise test and exercise prescription guide[M]. 10 ed. Beijing: People’s Health Publishing House, 2019:12-37.
[35]	魏丽丽, 韩斌如. 以护士为主导的早期活动方案在机械通气患者中的应用研究[J]. 中华护理杂志, 2019, 54(12):1765-1770. DOI URL
	Wei LL, Han BR. Application of nurse-led early activity procedure in patients with mechanical ventilation[J]. Chin J Nurs, 2019, 54(12):1765-1770. DOI URL