CAJ | 학술논문

目的：探讨序贯康复治疗慢性阻塞性肺疾病( COPD)合并II型呼吸衰竭的疗效及对肺表面活性物质蛋白D(SP-D)、克拉细胞分泌蛋白(CC16)水平的影响。方法 COPD合并II型呼吸衰竭患者160例按照治疗方法不同分为观察组和对照组。观察组78例出院时给予序贯康复治疗方案；对照组82例给予常规出院指导。所有患者于出院后3、6、12个月统计以下指标：心率、呼吸频率、FEV1%预计值、FEV1/FVC(%)、呼吸困难评分、6 min步行距离、生活质量评分；于出院时、出院后12个月检测血清SP-D、CC16含量。结果出院时血清SP-D、CC16水平2组无明显差异( P >0.05),出院后12个月观察组均较3个月及对照组降低( P均<0.05)。出院后3个月2组心率和呼吸频率均无明显差异( P >0.05)；6、12个月观察组心率、呼吸频率较3个月及对照组改善( P均<0.05)；3个月2组肺功能无明显差异( P >0.05),6、12个月观察组肺功能较3个月及对照组明显改善( P <0.05)；呼吸困难、生活质量3个月2组无明显差异( P >0.05),6、12个月观察组均获明显改善( P <0.05),且改善幅度优于对照组( P <0.05)；6、12个月观察组6 min步行距离均获明显提高且优于同期对照组( P <0.05)。结论序贯康复治疗COPD合并II型呼吸衰竭,可有效改善患者生命体征及肺功能,减轻患者呼吸困难症状,提高生活质量,降低外周血 SP-D、CC16水平。
목적：탐토서관강복치료만성조새성폐질병( COPD)합병II형호흡쇠갈적료효급대폐표면활성물질단백D(SP-D)、극랍세포분비단백(CC16)수평적영향。방법 COPD합병II형호흡쇠갈환자160례안조치료방법불동분위관찰조화대조조。관찰조78례출원시급여서관강복치료방안；대조조82례급여상규출원지도。소유환자우출원후3、6、12개월통계이하지표：심솔、호흡빈솔、FEV1%예계치、FEV1/FVC(%)、호흡곤난평분、6 min보행거리、생활질량평분；우출원시、출원후12개월검측혈청SP-D、CC16함량。결과출원시혈청SP-D、CC16수평2조무명현차이( P >0.05),출원후12개월관찰조균교3개월급대조조강저( P균<0.05)。출원후3개월2조심솔화호흡빈솔균무명현차이( P >0.05)；6、12개월관찰조심솔、호흡빈솔교3개월급대조조개선( P균<0.05)；3개월2조폐공능무명현차이( P >0.05),6、12개월관찰조폐공능교3개월급대조조명현개선( P <0.05)；호흡곤난、생활질량3개월2조무명현차이( P >0.05),6、12개월관찰조균획명현개선( P <0.05),차개선폭도우우대조조( P <0.05)；6、12개월관찰조6 min보행거리균획명현제고차우우동기대조조( P <0.05)。결론서관강복치료COPD합병II형호흡쇠갈,가유효개선환자생명체정급폐공능,감경환자호흡곤난증상,제고생활질량,강저외주혈 SP-D、CC16수평。
Objective To investigate the effect of sequential treatment on chronic obstructive pulmonary disease ( COPD) with type II respiratory failure and effect on protein on pulmonary surfactant D( SP-D) , Clara cell secretory protein 16-kD (CC16) level. Methods One hundred and sixty patients with COPD complicated with type II respiratory failure were enrolled, according to the different treatment methods, they were divided into observation group and control group. Seventy-eight cases in observation group were given rehabilitation program of sequential discharge;82 patients in control group received routine discharge guidance. All patients were followed up after 3, 6 and 12 months, the following index were analyzed:heart rate, respiratory frequency, FEV1% predicted, FEV1/FVC(%) , dyspnea score, 6 min walking distance and quality of life score;discharged from the hospital after 12 months' serum SP-D and CC16 content. Results At the time of discharge, serum SP-D and CC16 level had no difference between the 2 groups ( P >0. 05), after 12 months, observation group's indices were lower than 3 months and the control group ( P <0.05). 3 months after discharge, two groups'heart rate and respiratory rate revealed no significantly different ( P >0. 05);at 6, 12 month, observation group's heart rate, respiratory rate were improved than three months and the control group ( P <0. 05);3 months' lung function revealed no significant difference between the two groups ( P >0. 05), at 6, 12 months'lung function in the observation group were improved significantly than three months and the control group ( P <0. 05); dyspnea, quality of life at 3 months revealed no significant difference between the 2 groups ( P >0. 05), at 6 and 12 months, in the observation group, these indices were significantly improved ( P <0. 05), and the improvement were obviously than the control group ( P <0. 05);at 6 and 12 months,in the observation group,6 min walking distance were improved significantly than the same period control group ( P <0. 05). Conclusion Sequential reha-bilitation can effectively improve patient vital signs and lung function,reduce symptoms and difficulty breathing,improve quali-ty of life, reduce peripheral SP-D, CC16 levels for treating of COPD patients with type II respiratory failure.