Efficacy of progressive respiratory rehabilitation training in middle-aged and young patients with post-tuberculosis lung disease

doi:10.19983/j.issn.2096-8493.20250131

Abstract

Abstract:

Objective: To investigate the effects of progressive respiratory rehabilitation training on pulmonary function, exercise endurance, and quality of life in middle-aged and young patients with post-tuberculosis lung disease (PTLD). Methods: In this prospective study, 77 middle-aged and young PTLD patients admitted to the Department of the Third Pulmonary Disease, Shenzhen Third People’s Hospital between September 2022 and June 2024 were enrolled according to inclusion criteria. Eligible patients were randomly assigned, using a random number table, to either a control group (n=38; receiving conventional specialized nursing and respiratory rehabilitation exercises) or a observation group (n=39; receiving progressive intensive respiratory rehabilitation training in addition to the control regimen). Both groups received individualized case management for 6 months. Pulmonary function indices (FEV₁%, FVC%), exercise endurance (6-minute walk distance (6MWD)), grip strength, and quality of life (SF-36 scores) were assessed before the intervention, and at 1 and 6 months post-intervention. Results: At one month after the intervention, the observation group’s 6MWD was significantly lower than that of the control group ((461.77±84.49) m vs. (506.47±78.43) m; t=2.405, P=0.019). However, by six months, the 6MWD in the observation group was significantly higher than in the control group ((580.05±78.68) m vs. (532.61±88.18) m; t=2.493, P=0.015). Similarly, at six months, the observation group demonstrated significantly greater improvements in grip strength ((32.13±6.05) kg vs. (28.76±8.10) kg; t=2.072, P=0.042), FEV₁% ((74.77±12.76) % vs. (66.76±19.31) %; t=2.140, P=0.036), and FVC% ((86.97±14.17) % vs. (79.01±16.61) %; t=2.268, P=0.026) than the control group. In addition, the mental health scores of the observation group improved to (72.03±13.32) points one month after the intervention, while the overall quality of life scores increased to (636.66±82.28) points at six months. Both scores were significantly higher than those of the control group (65.39±13.40) and (562.64±83.07) points, respectively, with statistically significant differences (t=2.178, P=0.033; t=3.928, P<0.001). Conclusion: Progressive respiratory rehabilitation training markedly enhances exercise endurance, improves pulmonary function, and elevates the quality of life in middle-aged and young patients with post-tuberculosis lung disease. These findings support the broader clinical application in the management of PTLD.

Key words: Tuberculosis, pulmonary, Prognosis, Lung diseases, Middle aged, Rehabilitation nursing, Breathing exercises

CLC Number:

R52
R473.5

Wang Xiufen, Luo Li, Song Meijuan, Yu Cuiying, Liu Huan, Wei Ran, Zhang Dandan, Li Jian. Efficacy of progressive respiratory rehabilitation training in middle-aged and young patients with post-tuberculosis lung disease[J]. Journal of Tuberculosis and Lung Disease , 2026, 7(1): 92-100. doi: 10.19983/j.issn.2096-8493.20250131

Figures/Tables 6

指标		干预前	干预后1个月	t值		P值^a		干预后6个月	t值		P值^b
生理功能
对照组		75.39±10.80	80.34±10.00	2.512		0.016		82.18±12.79	3.217		0.003
观察组		69.23±21.32	79.36±15.36	3.322		0.002		89.15±11.53	4.978		<0.001
t值		1.606	0.332					2.510
P值		0.114	0.741					0.014
生理职能
对照组		57.24±21.68	60.47±19.50	1.008		0.326		60.39±25.56	3.217		0.003
观察组		58.33±27.71	62.72±20.89	1.193		0.243		72.82±22.62	3.702		0.001
t值		0.194	0.487					2.261
P值		0.847	0.628					0.027
躯体疼痛
对照组		71.74±16.35	75.21±13.37	1.134		0.264		76.16±16.49	1.173		0.248
观察组		73.64±22.30	75.46±15.65	0.687		0.496		85.05±13.07	3.195		0.003
t值		0.426	0.076					2.627
P值		0.671	0.940					0.010
总体健康
对照组		50.24±19.75	57.39±17.96	3.582		0.001		60.58±17.78	3.643		0.001
观察组		45.18±17.07	56.10±15.70	4.825		<0.001		68.90±15.22	8.820		<0.001
t值		1.203	0.336					2.208
P值		0.233	0.737					0.030
活力
对照组		63.68±13.19	68.42±15.21	2.229		0.032		67.63±16.23	1.503		0.141
观察组		59.23±18.12	67.13±16.13	3.233		0.003		74.90±14.21	5.210		<0.001
t值		1.235	0.362					2.091
P值		0.221	0.719					0.040
社会功能
对照组		71.61±15.34	76.93±11.12	2.028		0.050		80.24±18.09	1.955		0.058
观察组		68.79±14.18	75.42±12.96	2.123		0.040		88.85±11.64	6.256		<0.001
t值		0.836	0.550					2.490
P值		0.406	0.584					0.015
情感职能
对照组		49.86±32.53	66.38±23.45	3.738		0.001		66.56±23.60	3.667		0.001
观察组		51.32±26.98	67.44±17.63	4.842		<0.001		80.07±18.24	6.612		<0.001
t值		0.214	0.225					2.397
P值		0.831	0.822					0.019
精神健康
对照组		65.61±13.82	65.39±13.40	0.100		0.921		66.89±14.65	0.463		0.646
观察组		65.64±15.73	72.03±13.32	3.483		0.001		76.92±15.41	4.831		<0.001
t值		0.011	2.178					2.925
P值		0.992	0.033					0.005
生理健康评分
对照组	254.61±35.71		273.42±37.16		3.812		0.001	279.32±51.08		3.259		0.002
观察组	246.38±55.61		273.64±41.17		3.570		0.001	315.92±43.82		6.969		<0.001
t值	0.770		0.025					3.378
P值	0.444		0.980					0.001
心理健康评分
对照组	250.76±49.74		277.13±38.01		4.193		<0.001	283.33±42.53		3.963		<0.001
观察组	244.99±47.25		282.02±41.41		4.584		<0.001	320.74±42.99		8.334		<0.001
t值	0.552		0.539					3.838
P值	0.603		0.592					<0.001
总评分
对照组	505.36±77.06		550.55±66.44		5.200		<0.001	562.64±83.07		4.468		<0.001
观察组	491.37±92.66		555.66±76.26		4.436		<0.001	636.66±82.28		8.203		<0.001
t值	0.719		0.313					3.928
P值	0.474		0.755					<0.001

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特征	对照组(38例)	观察组(39例)	统计检验值	P值
性别			χ²=0.687	0.407
男性	14(36.8)	18(46.2)
女性	24(63.2)	21(53.8)
年龄(岁,$\bar{x}±s$)	34.74±9.57	38.26±12.14	t=1.410	0.163
年龄组(岁)			χ²=3.317	0.345
18~26	10(26.3)	7(17.9)
27~35	10(26.3)	11(28.2)
36~44	11(28.9)	8(20.5)
45~53	7(18.5)	13(33.4)
住院时长(d,$\bar{x}±s$)	11.11±5.68	9.72±6.70	t=0.979	0.331
婚姻状况			χ²=1.824	0.410
未婚	16(42.1)	12(30.8)
已婚	22(57.9)	27(69.2)
文化程度			χ²=4.481	0.205
小学	0(0.0)	3(7.7)
初中	14(36.8)	15(38.5)
高中	16(42.1)	10(25.6)
大学及以上	8(21.1)	11(28.2)
吸烟			χ²=0.502	0.711
是	3(7.9)	5(12.8)
否	35(92.1)	34(87.2)
疾病类型			χ²=0.345	0.557
初治	27(71.1)	30(76.9)
复治	11(28.9)	9(23.1)

训练阶段	训练内容
第一阶段: 肌力0~2级	1.鼓励患者用意念活动下肢拇指及手指,渐渐过渡到用拇指、脚底踩踏软垫或健侧拇指与患侧拇指“打架”等,然后在肌力提升到2级时鼓励患者下肢平行移动或屈膝辅助踏车运动 2.体位管理:床头抬高30°~45°,每2h被动翻身1次
第二阶段: 肌力3~4级	1.监督患者自行完成空中踏车、拉伸起坐和拱桥运动,次数逐渐增加,直至每个动作至少重复20个,3组/次,3次/d 2.呼气肌肉和气道廓清训练:呼吸训练器从绿色(5cmH₂O阻力)开始练习,逐渐上调阻力值,以患者吹气时发出噗噗声为达标,每次锻炼10组,每组用力吹呼吸训练器5下,并主动有效咳嗽2次,清除气道分泌物,每组间暂停2~3s,3组/次,3次/d
第三阶段: 肌力5级	1.进行标准的郑氏康复操训练 2.吸气肌肉训练:克服脐周2.5~5kg重物负荷的鼓腹运动至少20个呼吸周期,3组/次,3次/d 3.呼气肌肉和气道廓清训练:调节呼吸训练器呼气阈值阻力为25cmH₂O,每次呼气尽可能延长呼气时间,保持均匀呼出,每次锻炼10组,吹5下,咳两下,3组/次,3次/d 4.下床走路进行有氧运动,可携带呼吸机或者氧气,至少10min以上

组别	FEV₁(%,$\bar{x}±s$)							FVC(%,$\bar{x}±s$)
组别	干预前	干预后 1个月	t值	P值^a	干预后 6个月	t值	P值^b	干预前	干预后 1个月	t值	P值^a	干预后 6个月	t值	P值^b
对照组 (38例)	59.32± 23.25	60.92± 18.18	0.076	0.454	66.76± 19.31	2.643	0.012	74.99± 23.72	74.61± 16.34	0.155	0.878	79.01± 16.61	1.396	0.170
观察组 (39例)	51.34± 24.22	59.99± 22.03	3.455	0.001	74.77± 12.76	7.949	<0.001	67.19± 27.45	73.99± 21.99	2.765	0.009	86.97± 14.17	5.984	<0.001
t值	1.475	0.202			2.140			1.332	0.143			2.268
P值	0.144	0.840			0.036			0.187	0.887			0.026