Study On The Effects Of Pulmonary Rehabilitation On COPD Stable Patients With Grade 3 Of GOLD

Objective:To compare the compliance,motor function,lung function,quality of life,anxiety and depression,the number of acute exacerbations and the rehospitalization time of COPD patients with grade 3 in the lung rehabilitation group and the control group,and to evaluate the effect of pulmonary rehabilitation on COPD patients with grade 3.Methods:Seventy-four COPD patients with grade 3 of Gold who were hospitalized in the pneumology department of Ganmei Hospital Affiliated to Kunming Medical University from April 2019 to February 2020 due to acute exacerbation were selected and randomly divided into two groups(n=37).The control group was treated with routine treatment(health education),On the basis of this,the rehabilitation group was intervened with pulmonary rehabilitation treatment scheme immediately after the condition stabilized.The patients were followed up for 12 months(telephone follow-up with doctor supervision every 30 days,on-site follow-up in the first,sixth and twelfth months).The changes of 6MWT,lung function,cat score,mMRC score,SGRQ score,HADS score,times of acute exacerbation and rehospitalization time were observed before and after the intervention in the two groups at different follow-up stages,and the otherness of curative effect between the two groups were analyzed and compared.Results:After one month of intervention,there was little important difference between the two groups before and after intervention in 6MWT walking distance,heart rate,oxygen saturation,change value and wheezing/fatigue Borg score(P>0.05);pulmonary function(FEV1,FVC,FEVi/FVC and FEV1%pred)between the two groups had little significant change(P>0.05);CAT score of rehabilitation group was improved(P<0.05),while mMRC score was only decreased(P>0.05).After 6 months of intervention,there were significant differences in 6MWT walking distance and breathing Borg score at the end of walking in the rehabilitation group before and after intervention(P<0.05),but there were little important differences in fatigue Borg score,oxygen saturation and heart rate between the two groups before and after intervention(P>0.05);there was little important change in pulmonary function between the two groups before and after intervention,only FEV1%pred in the rehabilitation group compared with before intervention,was improved(P<0.05);CAT and mMRC scores in rehabilitation group were significantly decreased(P<0.01);there was little significant difference in the anxiety score of HADS between the two groups before and after intervention(P>0.05),but the depression score in rehabilitation group was decreased(P<0.05);compared with before intervention,the symptom score,activity score,influence score and total score of SGRQ in rehabilitation group were decreased(P<0.05)There was little significant improvement on SGRQ scores in the control group(P>0.05).After 12 months of intervention,6MWT walking distance,wheezing score and oxygen saturation of rehabilitation group were importantly different from those before treatment(P<0.05),heart rate change only decreased(P>0.05),and Borg fatigue score had little significant change(P>0.05);FEV1,FEV1%pred of rehabilitation group before and after intervention increased(P<0.05),FEVi/FVC and FVC had only slight changes(P>0.05),but the lung function of the control group had little change(P>0.05);compared with before intervention,CAT and mMRC scores of the rehabilitation group were significantly decreased(P<0.01),but CAT and mMRC scores of the control group were decreased and the difference was not statistically significant(P>0.05);The scores of anxiety and depression in the control group were little significantly different before and after the treatment(P>0.05);the SGRQ symptom score,activity score,influence score and total score in the rehabilitation group were importantly decreased before and after the intervention(P<0.01),while the activity score and total score in the observation group were little decreased and the influence score was not significantly different.There was little significant difference(P>0.05).The total completion rate of this study was 83.78%(62/74),89.18%(33/37)in the rehabilitation group and 78.37%(29/37)in the control group.There were no serious adverse reactions and no increased risk of acute exacerbation or death.Compared with before intervention,the times of hospitalization and acute exacerbation in rehabilitation group were significantly reduced,and the times of hospitalization in rehabilitation group were importantly less than those in control group(P<0.01),but there was little significant difference in the times of hospitalization in control group before and after intervention(P>0.05);compared with control group,the rehospitalization time in rehabilitation group was significantly longer(P>0.05),and the median time from admission to rehospitalization in rehabilitation group was 256 days,and that in control group was 1 38 days.Conclusions:1.The compliance and test completion of the treatment group were higher than those of the observation group.2.It is safe and feasible to carry out pulmonary rehabilitation immediately after the condition of GOLD grade 3 AECOPD patients is stable.3.Pulmonary rehabilitation can improve the respiratory symptoms,depression,exercise tolerance and quality of life of COPD patients,even FEVi and FEV1%pred were improved.The longer the intervention time is,the better the effect is.4.Pulmonary rehabilitation can significantly prolong the rehospitalization time of COPD patients,and reduce the acute exacerbation and hospitalization times.