以行动研究法为指导的组合式呼吸训练对老年慢性阻塞性肺疾病的效果

doi:10.3969/j.issn.1006-9771.2025.12.011

摘要/Abstract

摘要：

目的探讨以行动研究法为指导的组合式呼吸训练在老年慢性阻塞性肺疾病(COPD)患者中的应用效果。
方法 2024年10月至2025年3月，安徽医科大学附属阜阳医院老年COPD患者108例，随机分为对照组(n = 54)和观察组(n = 54)。对照组接受常规干预，观察组增加以行动研究法为指导的组合式呼吸训练，共8周。干预前后，观测用力肺活量(FVC)、最大通气量(MVV)、第1秒用力呼气量(FEV₁)、最大吸气压(MIP)、6分钟步行试验(6MWT)、慢性阻塞性肺疾病评估测试(CAT)，以及干预期间急性加重发生率。
结果对照组脱落3例，观察组脱落5例。干预后，两组FVC、MVV、FEV₁、MIP、6MWT和CAT评分均显著改善(|t| > 4.637, P < 0.001)，且观察组均优于对照组(|t| > 2.293, P < 0.05)。两组干预期间均未发生急性加重事件。
结论以行动研究法为指导的组合式呼吸训练可提高老年COPD患者呼吸功能和运动能力，提高生活质量，不会增加急性加重风险。

关键词: 慢性阻塞性肺疾病, 老年, 呼吸训练, 行动研究法

Abstract:

Objective To explore the effect of comprehensive respiratory training guided by action research method on old patients with chronic obstructive pulmonary disease (COPD).
Methods From October, 2024 to March, 2025, 108 old patients with COPD at Fuyang Hospital of Anhui Medical University were randomly divided into control group (n = 54) and observation group (n = 54). The control group received routine intervention, while the observation group received a comprehensive respiratory training guided by action research method in addition, for eight weeks. They were measured forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory volume in one second (FEV₁), maximal inspiratory pressure (MIP) and 6-minute walk test (6MWT) before and after the intervention, and assessed with Chronic Obstructive Pulmonary Disease Assessment Test (CAT); the occurrence of acute exacerbation during the intervention period was recorded.
Results Three cases in the control group and five cases in the observation group dropped down. FVC, MVV, FEV₁, MIP, 6MWT and CAT score improved in both groups (|t| > 4.637, P < 0.001) after intervention, and they were better in the observation group than in the control group (|t| > 2.293, P < 0.05). No acute exacerbation occurred during intervention in both groups.
Conclusion Comprehensive respiratory training guided by action research method can improve the respiratory function and motive ability of old patients with COPD, as well as the quality of life, without increasing the risk of acute exacerbation.

Key words: chronic obstructive pulmonary disease, aged, respiratory training, action research method

中图分类号:

R562

赵文, 王灿, 李丽文. 以行动研究法为指导的组合式呼吸训练对老年慢性阻塞性肺疾病的效果[J]. 《中国康复理论与实践》, 2025, 31(12): 1464-1471.

ZHAO Wen, WANG Can, LI Liwen. Effect of comprehensive respiratory training using action research method on old patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(12): 1464-1471.

图/表 5

表1

表2

表3

治疗前后两组呼吸功能比较"

变量	组别	n	测试	$x - ± s$	t值	P值	Cohen's d
FVC/L	对照组	51	前测	2.81±0.87	-4.637	< 0.001	-0.918
	对照组	51	后测	3.56±0.76
	观察组	49	前测	2.79±0.83	-6.519	< 0.001	-1.317
	观察组	49	后测	3.87±0.81
	干预前两组均值差			0.02±0.01	-0.118	0.908
	干预后两组均值差			0.31±0.18	-2.293	0.024
MVV/(L·min^-1)	对照组	51	前测	78.32±7.15	-13.722	< 0.001	-2.717
	对照组	51	后测	96.28±6.02
	观察组	49	前测	79.27±7.21	-16.908	< 0.001	-3.416
	观察组	49	后测	102.46±6.34
	干预前两组均值差			0.95±0.47	-0.662	0.510
	干预后两组均值差			5.98±0.42	-5.000	< 0.001
FEV₁/L	对照组	51	前测	3.24±0.54	-6.118	< 0.001	-1.212
	对照组	51	后测	4.11±0.86
	观察组	49	前测	3.19±0.69	-10.032	< 0.001	-2.027
	观察组	49	后测	4.64±0.74
	干预前两组均值差			0.05±0.02	-0.404	0.687
	干预后两组均值差			0.53±0.24	-3.298	0.001
MIP/cmH₂O	对照组	51	前测	61.45±4.53	-6.882	< 0.001	-1.371
	对照组	51	后测	69.42±6.86
	观察组	49	前测	62.33±4.41	-10.550	< 0.001	-2.131
	观察组	49	后测	74.52±6.78
	干预前两组均值差			0.88±0.43	-0.984	0.328
	干预后两组均值差			5.14±2.36	-3.738	< 0.001

表3

表4

治疗前后两组6MWT比较"

组别	n	测试	$x - ± s$	t值	P值	Cohen's d
对照组	51	前测	304.55±13.74	-23.472	< 0.001	-4.648
对照组	51	后测	375.78±16.76
观察组	49	前测	308.48±14.95	-34.429	< 0.001	-6.959
观察组	49	后测	425.25±18.43
干预前两组均值差			3.93±1.68	-1.370	0.174
干预后两组均值差			49.47±27.33	-14.053	< 0.001

表4

表5

治疗前后两组CAT评分比较"

组别	n	测试	$x - ± s$	t值	P值	Cohen's d
对照组	51	前测	23.71±6.74	-7.581	< 0.001	1.501
对照组	51	后测	14.66±5.22
观察组	49	前测	22.97±7.03	-9.900	< 0.001	2.000
观察组	49	后测	11.41±4.17
干预前两组均值差			-0.74±0.43	-0.037	0.592
干预后两组均值差			-3.25±1.74	-3.431	0.001

表5

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组别	n	性别(男/女)/n	年龄/岁	高血压(有/无)/n	糖尿病(有/无)/n	COPD病程/年
对照组	51	40/11	76.33±7.66	10/41	7/44	7.24±2.54
观察组	49	40/9	76.18±7.59	11/38	5/44	7.21±2.61
χ²/t值		0.160	0.098	0.122	0.294	0.058
P值		0.689	0.922	0.727	0.588	0.954

问题	解决方案	第一轮改进方案	最终方案
对缩唇呼吸体位耐受性较差	提供符合人体工学的支撑设备，如腰托或可调节靠背椅；缩短单次训练时间并增加组间休息时间；改直立位为扶立位	提供符合人体工学的支撑设备，如腰托或可调节靠背椅	提供符合人体工学的支撑设备，如腰托或可调节靠背椅
对呼吸肌训练耐受性差	调整起始强度为30% MIP、每周阻力增幅调整为3%，每次连续进行3~5组下调为2组	每周阻力增幅调整为3%、每次连续进行3~5组下调为2组	每周阻力增幅调整为3%
对床上坐起训练耐受性差	将“利用上肢力量将上半身拉起至坐直”改为“先屈膝90°再坐起”；床栏提供抓握辅助，如手缠绷带	将“利用上肢力量将上半身拉起至坐直”改为“先屈膝90°再坐起”	将“利用上肢力量将上半身拉起至坐直”改为“先屈膝90°再坐起”
桥式运动存在安全隐患	下调抬臀高度为≤ 8 cm或患者最大耐受极限，双膝间夹软枕以预防股骨内旋损伤，下落时先落腰再落臀	下调抬臀高度为≤ 8 cm或患者最大耐受极限，下落时先落腰再落臀	下调抬臀高度为≤ 8 cm或患者最大耐受极限，下落时先落腰再落臀
空中踏车负荷过大	屈髋角度≤ 45°，采用左右腿单侧交替训练，起始训练时间调整为每侧30 s	屈髋角度≤ 45°，采用左右腿单侧交替训练，起始训练时间调整为每侧30 s	屈髋角度≤ 45°，采用左右腿单侧交替训练，起始训练时间调整为每侧30 s