慢性阻塞性肺疾病稳定期患者居家肺康复临床规范

周传林; 黄海珠; 邓宁; 刘锐; 孔晋亮

doi:10.16766/j.cnki.issn.1674-4152.004321

慢性阻塞性肺疾病稳定期患者居家肺康复临床规范

doi: 10.16766/j.cnki.issn.1674-4152.004321

1.
广西医科大学第一附属医院呼吸与危重症医学科，广西南宁 530021
2.
浙江大学生物医学工程与仪器科学学院，浙江杭州 310027
3.
广西中医药大学附属瑞康医院呼吸与危重症医学科，广西南宁 530011

基金项目:

广西科技计划项目桂科AB21196010

详细信息

通讯作者:
孔晋亮，E-mail: kjl071@163.com

中图分类号: R563
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- 文章访问数: 23
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- 被引次数: 0
出版历程
- 收稿日期: 2025-06-12
- 网络出版日期: 2026-04-01

Clinical practice protocol for home-based pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China

摘要

摘要: 慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是严重危害我国居民健康的重大慢病之一，在2024年已成为继高血压病、2型糖尿病后第3个被纳入国家基本公共卫生服务项目的慢性病。肺康复(又称呼吸康复)被认为是慢性呼吸道疾病患者康复的核心组成部分，是COPD患者非药物治疗的核心手段。然而，传统中心化的肺康复因受限于时间、空间、交通条件、成本等多重因素，其普及性与依从性均面临严峻挑战。居家肺康复模式以其便捷、可及的优势，成为突破这一困境的有效途径。本文旨在系统阐述COPD稳定期患者居家肺康复的临床规范，从其定义、适用对象、介入时机、持续时间、评估方法、运动及呼吸处方、安全性监测、注意事项、总结与展望等关键环节进行全面论述，以期为各级医疗机构医护人员提供清晰、实用的实践指导，最终达到减轻症状、延缓疾病进展、提升患者生活质量的综合管理目标。
- 慢性阻塞性肺疾病 /
- 稳定期 /
- 居家肺康复
Abstract: Chronic obstructive pulmonary disease (COPD) is one of the major chronic diseases that poses a serious threat to population health in China. In 2024, it was incorporated into the National Basic Public Health Service Program as the third targeted chronic disease, following hypertension and type 2 diabetes. Pulmonary rehabilitation (also known as respiratory rehabilitation) is recognized as a core component of rehabilitation for patients with chronic respiratory diseases and represents a cornerstone of non-pharmacological treatment for COPD patients. However, the widespread implementation of traditional center-based pulmonary rehabilitation is limited by multiple barriers, including time constraints, geographical distance, transportation difficulties, and financial cost, resulting in suboptimal participation and adherence. The home-based pulmonary rehabilitation model, with its advantages of convenience and accessibility, has emerged as an effective solution to overcome these difficulties. This article aims to systematically outline a clinical protocol for home-based pulmonary rehabilitation in patients with stable COPD. It comprehensively discusses key aspects, including definition, target population, optimal timing and duration of intervention, assessment methods, exercise and breathing prescriptions, safety monitoring, precautions, as well as a summary of future prospective. The goal is to provide clear and practical guidance for healthcare professionals across different levels of medical institutions, ultimately supporting comprehensive disease management aimed at symptom relief, delayed disease progression, and improved quality of life in patients with COPD.
- Chronic obstructive pulmonary disease /
- Stable phase /
- Home-based pulmonary rehabilitation

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图 1 居家肺康复实施流程图

Figure 1. Flowchart for the implementation of home-based pulmonary rehabilitation

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表 1 常用的肺康复评估内容^[22]

Table 1. Common contents of pulmonary rehabilitation assessment^[22]

分类	内容及方法	应用场景与说明
临床评估	现病史；既往史；共患病；体格检查	核心安全筛查，尤其在急性加重出院后启动康复前至关重要，用于排除禁忌证，评估康复风险。稳定期患者初期评估时亦需完成
检查评估	化验检查；影像学检查；心电图；超声心动图；电子支气管镜检查	安全性及鉴别诊断依据，主要用于急性加重后或存在可疑心血管等合并症的患者，为确保运动安全提供客观依据。稳定期患者根据临床需要选择
功能评估	肺功能；咳嗽峰流速；最大吸气压(maximal inspiratory pressure, MIP)；最大呼气压(maximal expiratory pressure, MEP)；跨膈压；膈肌超声；心肺运动试验(cardiopulmonary exercise testing, CPET)；6分钟步行试验；1分钟坐-站试验；徒手肌力检查；等长测力计；等张肌力检查；吞咽功能评估	康复处方制定与效果评价的核心。是稳定期患者评估的重点，用于客观量化受损程度，为制定个体化运动处方提供基准，并精确评估康复疗效
问卷评估	圣乔治呼吸问卷(St.George's respiratory questionnaire, SGRQ)；慢性呼吸系统疾病问卷(chronic respiratory disease questionnaire, CRQ)；慢性阻塞性肺疾病评估测试(COPD assessment test, CAT)；视觉模拟评分(visual analogue scale, VAS)；改良巴氏指数；工具性日常生活活动能力量表(instrumental activities of daily living scale, IADL)；改良呼吸困难指数(modified medical research council dyspnea scale, mMRC)；Borg量表；医院焦虑抑郁量表；匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)；营养筛查(nutritional risk screening 2002, NRS 2002)	贯穿全程，侧重患者主观体验与生活质量。稳定期用于全面了解症状负担、心理状态和生活质量，是评价康复综合获益的关键。急性加重后可用于快速筛查焦虑、抑郁、营养风险等影响预后的因素

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表 2 不同指南对COPD患者的运动建议总结

Table 2. Summary of exercise recommendations for COPD patients in different guidelines

运动要素	ACSM	ATS/ERS	AACVPR
耐力运动
方式	步行和/或骑自行车	骑自行车或步行(地面或跑步机)	步行(跑步机、跑道、助行器或轮椅支撑步行)、骑自行车、固定自行车、臂力测功计、台阶练习、划船、水中运动、改良有氧舞蹈，坐位有氧运动等
频率	3~5次/周(最少)	3~5次/周	3~5次/周
强度	低强度：30%~40%峰值功率；高强度：60%~80%峰值功率；替代标准：Borg CR10量表气促评分4~6分	>60%最大功率	高强度：60%~80%峰值功率
持续时间	无单次训练总时长的具体建议。时长建议基于COPD严重程度；中重度患者在训练初期可能仅能耐受特定强度数分钟，最初可能需要间歇性训练	20~60 min/次	20~60 min/次(持续4~12周)
进阶	基于健康和体能状况个体化制定。可参考适用于老年人的通用指南。初期：前4~6周内，每1~2周增加5~10 min，然后逐渐增加时长、频率和/或强度	按Borg量表滴定至症状4~6分或按主观努力评定(rating of perceived exertion，RPE)量表滴定至症状12~14分	选项包括滴定至选定的RPE水平、呼吸困难水平或预定的代谢当量水平
注解	在个体能够忍受较长时间的运动之前，最初可采用间歇性训练。据报道，高强度的短时间、间歇性训练可降低症状评分	对因症状限制而无法忍受持续训练的个体，应考虑间歇性训练	对于无法维持长时间连续高强度运动的个人，应考虑进行间歇性训练。强调运动前的热身和运动后的放松
抗阻运动	注意：ACSM指南不包括针对COPD患者抗阻训练和柔韧性练习的具体建议，但参考了针对老年人和健康成年人的建议。以下陈述反映了这些建议	抗阻运动应遵循与健康和/或老年人运动处方相同的FITT原则	未说明
方式	强调功能性活动(如爬楼梯)；自由举重、器械抗阻、弹力带	重复提举相对较重的负荷	举重：手部和踝部重量、自由重量、器械重量、弹力带阻力、利用自身体重(爬楼梯、深蹲)
频率	≥2次/周	2~3次/周	未作说明
强度	低强度：1次重复最大值的40%~50%；中等强度：1次重复最大值的60%~70%	1次重复最大值的60%~70%，或8~12次重复最大值的100%	从较低重量/阻力和较高重复次数开始，以增加肌肉耐力。在个体化基础上，可采用较大重量和较少重复次数促进力量发展
持续时间	1~4套；8~10个练习；重复10~15次，以提高肌肉力量和耐力	未作说明	未作说明
进阶	逐渐增加阻力和/或重复次数和/或频率	增加重量、每组重复次数、每次训练的组数，或者当个人可以在连续2次训练中完成超过所需次数的1 ~2次重复时减少休息时间	监测RPE及肌肉/关节疲劳、酸痛和疼痛
注解	组间休息2~3 min；每次练习都使用适当的技巧；在整个运动范围内移动；使用正确的呼吸技巧；使用多关节和单关节练习来锻炼每个主要肌肉群	耐力训练是肺康复的主要内容。然而，阻力运动将带来更大的肌肉质量和肌肉力量增益，并减少呼吸困难	对于骨质疏松症，注意脊柱屈曲/旋转和大重量训练；对于肺动脉高压：低阻力训练和有节奏的呼吸，有氧训练是可以接受的

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