A randomized controlled trial of graded exercise rehabilitation enhances diaphragm function and exercise tolerance in patients with AECOPD.

Abstract

To evaluate the improvement effect of graded exercise rehabilitation on diaphragm function, exercise function, and respiratory performance in AECOPD patients. 68 AECOPD patients admitted to the Respiratory and Critical Care Department of a tertiary hospital in Zunyi City. Patients were randomly divided into a study group and a control group (each group 34 patients), and then according to the grading criteria, patients in each group were divided into 3 levels, for a total of 6 groups. The control group used conventional rehabilitation, while the study group used graded exercise rehabilitation. Bedside ultrasound was used to monitor the changes in diaphragm function (DE, DTei, DTee, DTF), 6MWT, CAT score, mMRC questionnaire, non-invasive mechanical ventilation time, and hospital stay between two groups of patients before and after rehabilitation. Compared with before the rehabilitation intervention, the study group showed significant improvement in diaphragm movement compared to the control group (P < 0.05). The end-inspiratory, end-expiratory, and diaphragm thickening scores all improved compared to before, and the differences were statistically significant (P < 0.05); The 6MWT and CAT scores of the study group were significantly higher than those of the control group after the intervention, and the difference was statistically significant (P < 0.05); Compared with the control group, the study group had significantly less mechanical ventilation time and hospitalization time, and the difference was statistically significant (both P < 0.05); The total incidence of MV related complications in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). There were no actual compression injuries, aspiration, deep vein thrombosis, atelectasis, etc. in either group; The mMRC questionnaire did not show statistical significance (P > 0.05), but there was improvement before the intervention. Graded exercise rehabilitation can effectively improve the overall diaphragm function of patients, and has a positive effect on enhancing exercise quality and endurance; Bedside ultrasound can dynamically and real-time observe the diaphragm movement status of AECOPD patients, objectively and directly evaluate the recovery of respiratory muscle function, and has important clinical value.