心肺运动试验指导综合性肺康复在尘肺病患者中的应用效果评价OA

[Background]At present,the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage.The basis for formu-lating an individualized comprehensive pulmonary rehabilitation plan is still insufficient,which is one of the factors limiting the development of community-level rehabilitation work. [Objective]To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test(CPET),con-duct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumo-coniosis,and evaluate its role in improving exercise endurance and quality of life,thus provide a basis for the application and promotion of pulmonary rehabilitation. [Methods]A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co.,Ltd.from April to August 2022,and were divided into an intervention group and a control group by random number table method,with 34 cases in each group.All the pneumoconiosis patients participated in a baseline test.The control group was given routine drug treatment,while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment,including health education,breathing training,exercise training,nutrition guidance,psychological interven-tion,and sleep management,whose exercise intensity was determined according to the maximum heart rate provided by CPET.The re-habilitation training lasted for 24 weeks.Patients were evaluated at registration and the end of study respectively.CPET was used to measure peak oxygen uptake per kilogram(pVO2/kg),anaerobic threshold(AT),carbon dioxide equivalent of ventilation(EqCO2),maximum metabolic equivalent(METs),and maximum work(Wmax).The modified British Medical Research Council Dyspnea Questionnaire(mMRC),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Pittsburgh Sleep Quality Index(PSQI),Chronic Obstructive Pulmonary Disease Assessment Test(CAT),and Short Form of Health Survey(SF-36)were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. [Results]Among the included 68 patients,63 patients were having complete data,then 31 cases were assigned in the control group and 32 cases in the interventional group.Before the intervention,there was no significant difference in pVO2/kg,AT,EqCO2,METs,or Wmax between the two groups(P>0.05).At the end of the trail,the indicators like pVO2/kg[(19.81±2.38)mL·(min·kg)-1],AT[(14.48±2.33)mL·(min·kg)-1],METs(5.64±0.69),and Wmax[(85.25±14)W]of patients in the intervention group were all higher than those[(13.90±2.37)mL·(min·kg)-1,(11.70±1.94)mL·(min kg)-1,(3.97±0.70),and(61.77±14.72)W,respectively]in the control group(P<0.001);there was no sig-nificant difference in EqCO2 between the two groups(P=0.083).Before the trial,there was no significant difference in mMRC,SAS,SDS,PSQI,or CAT scores between the two groups(P>0.05).At the end of the trail,the mMRC score(1.16±0.57),SAS score(27.93±2.12),SDS score(26.48±1.44),PSQI score(1.08±0.88),and CAT score(4.34±3.28)of patients in the intervention group were lower than those[(2.03±0.83),(35.87±6.91),(34.23±6.65),(5.37±3.03),and(13.87±7.53),respectively]in the control group(P<0.001).The SF-36 scores of bodily pain(94.13±10.72),general health(87.50±5.68),vitality(95.31±5.53),mental health(99.88±0.71),and health changes(74.22±4.42)in the intervention group were higher than those[(71.87±32.72),(65.81±15.55),(74.52±16.45),(86.97±16.56),and(29.84±13.50),respec-tively]in the control group(P<0.001),and no significant difference was found in social functioning and role emotional scores(P>0.05). [Conclusion]Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients,ameliorate dyspnea symptoms,elevate psychological state and sleep quality,and improve the quality of life.