呼吸康复对支气管哮喘患儿影响的前瞻性随机对照研究

doi:10.12372/jcp.2023.22e1353

摘要/Abstract

摘要：

目的探讨呼吸康复对哮喘患儿吸气肌肌力、运动能力、肺功能、哮喘控制水平和生存质量的影响。方法选择2021年6月至2022年2月于呼吸科门诊就诊的哮喘患儿，运用随机数字表将其随机分为试验组与对照组。对照组予以常规药物治疗及健康教育，试验组在此基础上联合呼吸康复，观察其对哮喘患儿的影响。结果纳入57例哮喘患儿，均完成6个月试验，男38例、女19例，平均年龄（9.4±2.3）岁，平均病程4.0（2.1~5.5）年。试验组31例、对照组26例。进行6个月训练后，试验组最大口腔吸气压平均值和最大值、6分钟步行距离、哮喘控制水平高于对照组，6分钟步行后心率和生存质量得分低于对照组，差异有统计学意义（P<0.05），但两组步行后血压和肺功能差异无统计学意义（P>0.05）。进行6个月训练后，试验组最大口腔吸气压平均值和最大值，6分钟步行距离，肺功能[用力肺活量（FVC）、第一秒用力呼气容积（FEV₁）、呼气峰流速（PEF）、75%和50%肺活量时的最大呼气流速（MEF₇₅、MEF₅₀）、用力呼气中期流速（MMEF_75/25）]，哮喘控制水平高于干预前，6分钟步行后心率、收缩压和生存质量得分低于干预前；对照组最大口腔吸气压平均值和肺功能（FEV₁、FEV₁/FVC、MEF₇₅、MEF₅₀、MEF₂₅、MMEF_75/25）高于干预前，差异均有统计学意义（P<0.05）。结论在规范化治疗的基础上结合呼吸康复能改善哮喘患儿的吸气肌肌力、运动能力、哮喘控制水平和生存质量，且具有良好的安全性，临床工作者可将呼吸康复应用于哮喘患儿以期获得更好的疗效。

关键词: 支气管哮喘, 呼吸康复, 肺功能, 生存质量, 儿童

Abstract:

Objective To investigate the effect of respiratory rehabilitation on inspiratory muscle strength, exercise capacity, pulmonary function, asthma control level and quality of life in children with asthma. Methods The children with asthma treated in respiratory outpatient department from June 2021 to February 2022 were selected and randomly divided into experimental group and control group using a random number table. The control group was given routine drug treatment and health education, while the experimental group was combined with respiratory rehabilitation to observe its effects on children with asthma.Results A total of 57 children with asthma were included, all completed the 6-month experiment. There were 38 boys and 19 girls, with the average age of (9.4±2.3) years and the average disease course of 4.0 (2.1-5.5) years. There were 31 children in the experimental group and 26 children in the control group. After 6 months of training, the mean and maximum values of maximum oral inspiratory pressure, 6-minute walking distance, and asthma control level in the experimental group were higher than those in the control group (P<0.05), and the heart rate and quality of life scores after 6-minute walking were lower than those in the control group (P<0.05), but there was no significant difference in blood pressure and pulmonary function between the two groups (P>0.05). After 6 months of training, the mean and maximum values of maximum oral inspiratory pressure, 6-minute walking distance, lung function (FVC, FEV₁, PEF, MEF₇₅, MEF₅₀, MMEF_75/25), asthma control level in the experimental group were higher than those before the intervention (P<0.05), heart rate, systolic blood pressure and quality of life scores in the experimental group were lower than before the intervention (P<0.05), the mean value of maximum oral inspiratory pressure and pulmonary function (FEV₁, FEV₁/FVC, MEF₇₅, MEF₅₀, MEF₂₅, MMEF_75/25) in the control group were higher than those before the intervention (P<0.05). Conclusions Combining respiratory rehabilitation with standardized treatment can improve inspiratory muscle strength, exercise capacity, asthma control level and quality of life in children with asthma, and has good safety. Clinicians can apply respiratory rehabilitation to asthma patients in order to obtain better curative effect.

Key words: bronchial asthma, respiratory rehabilitation, lung function, quality of life, child

杨姝晖, 刘玉琳, 杨帆, 罗征秀, 刘恩梅. 呼吸康复对支气管哮喘患儿影响的前瞻性随机对照研究[J]. 临床儿科杂志, 2023, 41(5): 345-352.

YANG Shuhui, LIU Yulin, YANG Fan, LUO Zhengxiu, LIU Enmei. Effect of respiratory rehabilitation on children with bronchial asthma: a prospective randomized controlled study[J]. Journal of Clinical Pediatrics, 2023, 41(5): 345-352.

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项目	试验组(n=31)	对照组(n=26)	统计量	P
年龄(x±s)/岁	9.2±2.0	9.5±2.6	t=0.49	0.628
男性[n(%)]	21(67.7)	17(65.4)	χ²=0.04	0.851
病程[M(P₂₅~P₇₅)]/年	4.0(2.8~6.0)	4.0(1.9~5.0)	Z=0.43	0.668
身高(x±s)/cm	137.6±12.0	138.9±15.2	t=0.38	0.706
体重(x±s)/kg	33.7±10.7	33.1±10.6	t=0.23	0.816
体质指数[M(P₂₅~P₇₅)]/kg·m^-2	17.2(14.6~20.7)	16.4(14.2~18.8)	Z=1.28	0.200
主要照护者年龄[M(P₂₅~P₇₅)]/岁	37.0(35.0~39.3)	38.5(34.8~44.0)	Z=0.24	0.810
主要照护者受教育程度[n(%)]			Z=0.82	0.410
高中/中专及以下	7(22.6)	11(42.3)
大学/大专	24(77.4)	12(46.2)
研究生	0(0)	3(11.5)
哮喘对家庭经济影响[n(%)]			Z=1.46	0.144
没有影响	14(45.2)	4(15.4)
轻度影响	11(35.5)	19(73.1)
中度影响	6(19.4)	2(7.7)
重度影响	0(0)	1(3.8)
吸入药物[n(%)]			χ²=7.06	0.115
丙酸氟替卡松气雾剂50μg	3(9.7)	0(0)
丙酸氟替卡松气雾剂125μg	2(6.5)	4(15.4)
沙美特罗替卡松气雾剂125μg	13(41.9)	5(19.2)
沙美特罗替卡松粉吸入剂100μg	10(32.3)	12(46.2)
布地奈德福莫特罗吸入粉雾剂80μg	3(9.7)	5(19.2)
吸入药物频率[n(%)]			χ²=0.57	0.452
1次/d	15(48.4)	10(38.5)
2次/d	16(51.6)	16(61.5)

组别	例数	MIP平均值/cmH₂O		t值	P	MIP最大值/cmH₂O		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	39.0±11.0	62.0±16.1	10.60	<0.001	49.7±12.4	71.0±17.2	8.61	<0.001
对照组	26	41.4±10.8	46.8±12.7	3.45	0.002	53.8±13.1	55.5±16.1	0.79	0.437
t值		0.84	3.89			1.20	3.49
P		0.403	<0.001			0.235	0.001

组别	例数	6MWD/m		t值	P	HR/次		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	574.0±79.6	610.2±68.0	4.62	<0.001	117.3±20.0	109.0±16.0	2.45	0.021
对照组	26	587.7±71.5	574.7±58.6	1.33	0.195	115.6±17.8	117.2±13.3	0.70	0.492
t值		0.68	2.09			0.35	2.09
P		0.499	0.041			0.731	0.042
组别	例数	SBP/mmHg		t值	P	DBP/mmHg		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	124.5±15.4	119.9±13.0	2.19	0.036	67.6±8.0	66.2±6.4	1.05	0.304
对照组	26	127.0±15.7	123.2±13.6	1.53	0.139	67.1±8.1	67.4±8.6	0.17	0.870
t值		0.59	0.93			0.25	0.56
P		0.557	0.355			0.803	0.576

组别	例数	FVC/%		t值	P	FEV₁/%		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	91.2±14.4	95.0±10.6	2.38	0.024	83.7±16.4	88.5±12.7	2.87	0.008
对照组	26	92.5±13.1	95.8±9.1	1.80	0.084	84.3±14.3	89.9±10.1	2.42	0.023
t值		0.36	0.28			0.15	0.48
P		0.724	0.777			0.880	0.623
组别	例数	FEV₁/FVC/%		t值	P	PEF/%		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	91.0±9.8	92.6±8.9	1.32	0.196	85.0±17.9	92.6±8.9	3.71	0.001
对照组	26	90.9±7.8	94.1±7.2	2.32	0.029	86.0±14.1	89.0±12.1	1.60	0.121
t值		0.04	0.67			0.22	1.01
P		0.968	0.504			0.829	0.317
组别	例数	MEF₇₅/%		t值	P	MEF₅₀/%		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	73.9±20.0	81.3±20.2	2.71	0.011	57.3±17.6	64.0±17.5	2.36	0.025
对照组	26	73.2±17.2	81.8±14.8	3.06	0.005	57.0±16.7	64.8±14.2	2.60	0.015
t值		0.13	0.12			0.06	0.18
P		0.895	0.902			0.950	0.860
组别	例数	MEF₂₅/%		t值	P	MMEF_75/25/%		t值	P
组别	例数	干预前	干预后	t值	P	干预前	干预后	t值	P
试验组	31	46.0±15.8	51.5±16.0	1.99	0.055	54.9±17.1	61.2±17.0	2.24	0.032
对照组	26	46.3±13.6	54.6±17.0	2.79	0.010	55.1±15.9	63.7±15.6	2.99	0.006
t值		0.07	0.72			0.03	0.58
P		0.944	0.477			0.973	0.566

组别	例数	干预前		干预后		χ²值	P
组别	例数	部分控制	完全控制	部分控制	完全控制	χ²值	P
试验组	31	12(38.7)	19(61.3)	4(12.9)	27(87.1)	5.39	0.020
对照组	26	9(34.6)	17(65.4)	10(38.5)	16(61.5)	0.08	0.773
χ²值		0.10 0.750		4.99 0.026
P		0.10 0.750		4.99 0.026