心肺康复运动对老年慢性阻塞性肺疾病并发慢性心力衰竭患者的效果

doi:10.3969/j.issn.1006-9771.2026.02.008

摘要/Abstract

摘要：

目的观察心肺康复运动提升老年慢性阻塞性肺疾病并发慢性心力衰竭(COPD-CHF)患者运动耐量和生活质量的效果。

方法 2023年3月至2024年1月在齐齐哈尔医学院附属第一医院住院的COPD-CHF患者100例，随机分为对照组(n = 50)和康复组(n = 50)。出院后，两组均予常规药物治疗，康复组进行心肺康复运动训练3个月。治疗前后采用心脏彩超测量左心室射血分数(LVEF)，心肺运动试验检测肺功能，并采用6分钟步行距离(6MWD)、COPD评估测试(CAT)和明尼苏达心力衰竭生活质量问卷(MLHFQ)进行评定。

结果两组各脱落4例。治疗后，康复组无氧阈、最大摄氧量、最大自主通气量、LVEF和6MWD均显著升高(t > 8.328, P < 0.001)，且显著优于对照组(t > 6.717, P < 0.001)；CAT和MLHFQ评分显著降低(t > 12.070, P < 0.001)，且均显著优于对照组(t > 8.297, P < 0.001)。

结论心肺康复运动能改善老年COPD-CHF患者的心肺功能，改善运动耐量和生活质量。

关键词: 慢性阻塞性肺疾病, 慢性心力衰竭, 心肺康复, 老年

Abstract:

Objective To observe the effect of cardiopulmonary rehabilitation exercise on exercise tolerance and quality of life in old patients with chronic obstructive pulmonary disease and chronic heart failure (COPD-CHF).

Methods A total of 100 old inpatients with COPD-CHF were recruited from the First Affiliated Hospital of Qiqihar Medical University between March, 2023 and January, 2024. They were randomly divided into control group (n = 50) and rehabilitation group (n = 50). After discharge, both groups received routine medication treatment, while the rehabilitation group additionally underwent cardiopulmonary rehabilitation exercise, for three months. Before and after intervention, left ventricular ejection fraction (LVEF) was measured with cardiac color Doppler ultrasound, and pulmonary function was evaluated with cardiopulmonary exercise testing; while they were assessed with the 6-minute walk distance (6MWD), COPD Assessment Test (CAT) and Minnesota Living with Heart Failure Questionnaire (MLHFQ).

Results Four patients dropped out from each group. Anaerobic threshold, maximum oxygen uptake, maximum voluntary ventilation, LVEF and 6MWD increased in the rehabilitation group after intervention, (t > 8.328, P < 0.001), and they were better than those in the control group (t > 6.717, P < 0.001); while the scores of CAT and MLHFQ decreased in the rehabilitation group (t > 12.070, P < 0.001), and they were better than those in the control group (t > 8.297, P < 0.001).

Conclusion Cardiopulmonary rehabilitation exercise can improve cardiopulmonary function, exercise tolerance and quality of life in old patients with COPD-CHF.

Key words: chronic obstructive pulmonary disease, chronic heart failure, cardiopulmonary rehabilitation, aged

中图分类号:

祁莉, 张雷, 漆毅, 冯立军, 刘冬梅, 马慧娜. 心肺康复运动对老年慢性阻塞性肺疾病并发慢性心力衰竭患者的效果[J]. 《中国康复理论与实践》, 2026, 32(2): 191-197.

QI Li, ZHANG Lei, QI Yi, FENG Lijun, LIU Dongmei, MA Huina. Effect of cardiopulmonary rehabilitation exercise on old patients with chronic obstructive pulmonary disease and chronic heart failure[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(2): 191-197.

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组别	n	性别(男/女)/n	年龄/岁	体质量指数/(kg·m^-2)	病程/年	高血压/n	糖尿病/n	冠心病/n
对照组	50	32/18	71.67±6.81	23.41±1.81	10.01±2.56	42	18	27
康复组	50	34/16	77.94±6.81	24.38±1.31	9.97±2.60	43	16	30
χ²/t值		0.045	0.430	0.218	0.078	0.088	0.178	0.378
P值		0.830	0.506	0.825	0.935	0.762	0.671	0.536

变量	组别	n	测试	$\bar{x} \pm s$	t值	P值
AT/(ml∙min^-1∙kg^-1)	对照组	46	前测	9.02±1.04	1.038	0.305
	对照组	46	后测	9.17±1.28	1.038	0.305
	康复组	46	前测	9.40±1.48	26.014	< 0.001
	康复组	46	后测	11.32±1.60	26.014	< 0.001
	治疗前两组均值差			0.38±0.27	1.396	0.167
	治疗后两组均值差			2.15±0.31	6.970	< 0.001
VO₂ max/(ml∙ min^-1∙kg^-1)	对照组	46	前测	13.60±1.46	0.728	0.470
	对照组	46	后测	13.65±1.57	0.728	0.470
	康复组	46	前测	13.53±1.54	13.513	< 0.001
	康复组	46	后测	16.79±2.02	13.513	< 0.001
	治疗前两组均值差			-0.07±0.31	0.160	0.873
	治疗后两组均值差			3.14±0.38	8.873	< 0.001
MVV/(L·min^-1)	对照组	46	前测	77.94±6.81	1.018	0.314
			后测	78.57±7.63
	康复组	46	前测	78.14±7.20	27.952	< 0.001
			后测	93.53±9.84
	治疗前两组均值差			0.20±1.46	0.136	0.892
	治疗后两组均值差			14.96±1.84	8.063	< 0.001
FVC/L	对照组	46	前测	3.41±0.46	0.146	0.884
			后测	3.41±0.47
	康复组	46	前测	3.40±0.47	0.407	0.686
			后测	3.41±0.48
	治疗前两组均值差			-0.01±0.10	0.086	0.932
	治疗后两组均值差			0.00±0.10	0.003	0.998
FEV₁/L	对照组	46	前测	2.89±0.21	0.696	0.490
			后测	2.91±0.21
	康复组	46	前测	2.88±0.21	0.984	0.331
			后测	2.92±0.21
	治疗前两组均值差			-0.01±0.04	0.324	0.746
	治疗后两组均值差			0.01±0.04	0.238	0.812

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	46	前测	34.06±2.30	1.411	0.166
对照组	46	后测	34.77±3.54	1.411	0.166
康复组	46	前测	34.48±2.31	11.567	< 0.001
康复组	46	后测	44.95±5.78	11.567	< 0.001
治疗前两组均值差			0.42±0.40	1.051	0.280
治疗后两组均值差			10.18±1.01	10.105	< 0.001

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	46	前测	387.98±47.32	0.732	0.466
对照组	46	后测	392.77±51.73	0.732	0.466
康复组	46	前测	396.70±47.33	8.328	< 0.001
康复组	46	后测	475.30±64.12	8.328	< 0.001
治疗前两组均值差			8.72±11.30	0.772	0.443
治疗后两组均值差			82.53±12.28	6.717	< 0.001

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	46	前测	24.12±4.34	19.191	< 0.001
对照组	46	后测	10.13±2.16	19.191	< 0.001
康复组	46	前测	24.16±4.58	12.070	< 0.001
康复组	46	后测	14.45±2.75	12.070	< 0.001
治疗前两组均值差			0.04±0.89	0.045	0.966
治疗后两组均值差			4.32±0.52	8.297	< 0.001