探讨心肺交互机制的整合性阶梯式呼吸康复训练对主动脉夹层(aortic dissection, AD)合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者术后心肺功能及预后的影响。

选取2022年1月至2025年6月我院收治的Stanford B型AD合并COPD并行主动脉夹层腔内隔绝术57例患者为对象，随机分为观察组28例和对照组29例。对照组接受氧疗、基础呼吸操训练及药物雾化吸入治疗，观察组在对照组基础上实施基于心肺交互的阶梯式呼吸康复训练。比较两组心功能指标、肺功能指标、运动耐力、N末端B型利钠肽原(NT-proBNP)水平及预后。

观察组治疗后左心室射血分数(left ventricular ejection fraction, LVEF)[(62.32±5.14)%比(58.20±4.83)%，t＝3.21，P＝0.002]、E/A[(1.24±0.18)比(0.96±0.21)，t＝5.02，P＝0.001]、右心室收缩末期面积变化率(right ventricular fractional area change, RVFAC)[(42.51±6.30)%比(36.84±5.73)%，t＝3.94，P＝0.001]、左心房容积指数(left atrial volume index, LAVI)[(28.32±5.45)ml/m²比(34.22±6.13)ml/m²，t＝4.08，P＝0.001]、收缩期肺动脉压(systolic pulmonary artery pressure, sPAP)[(36.71±6.14)mmHg比(42.30±5.81)mmHg，t＝3.57，P＝0.001]优于对照组；第1秒用力呼气容积(forced expiratory volume in one second, FEV₁)%[(72.52±7.15)%比(65.41±6.90)%，t＝4.15，P＝0.001]、FEV₁/FVC[(62.43±6.31)%比(58.94±5.82)%，t＝2.38，P＝0.021]、呼气峰流速(peak expiratory flow, PEF)[(4.25±0.83)L/s比(3.50±0.72)L/s，t＝3.76，P＝0.001]高于对照组；改良英国医学研究委员会呼吸困难量表(modified medical research council, mMRC)评分[(1.34±0.53)分比(1.81±0.60)分(t＝3.52，P＝0.001)]低于对照组；6 min步行试验(six-minute walk test, 6MWT)变化值[(105.0±38.4)m比(50.1±29.8)m(t＝5.92，P<0.001)]、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide, NT-proBNP)变化值[(－769.8±245.4)pg/ml比(－365.0±198.9)pg/ml(t＝6.28，P<0.001)]优于对照组。观察组治疗有效25例(89.29%)，不良事件3例(10.71%)；对照组治疗有效21例(68.97%)，不良事件8例(27.58%)(P<0.05)。

基于心肺交互机制的整合性阶梯式呼吸康复训练可改善AD合并COPD患者术后心肺功能、运动耐力及预后，降低不良事件发生率，具有临床意义。

To investigate the effect of integrated stepwise respiratory rehabilitation training based on the cardiopulmonary interaction mechanism on postoperative cardiopulmonary function and prognosis in patients with aortic dissection (AD) complicated with chronic obstructive pulmonary disease (COPD).

A total of 57 patients with Stanford type B AD complicated with COPD who underwent thoracic endovascular aortic repair in our hospital from January 2022 to June 2025 were enrolled and randomly divided into an observation group (28 cases) and a control group (29 cases). The control group received oxygen therapy, basic respiratory exercise training, and aerosol inhalation therapy, while the observation group additionally received integrated stepwise respiratory rehabilitation training based on the cardiopulmonary interaction mechanism. Cardiac function indices, pulmonary function indices, exercise tolerance, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and prognosis were compared between the two groups.

After treatment, compared with the control group, the observation group showed significantly better left ventricular ejection fraction (LVEF) [(62.32±5.14)% vs. (58.20±4.83)%, t=3.21, P=0.002], E/A ratio [(1.24±0.18) vs. (0.96±0.21), t=5.02, P=0.001], right ventricular fractional area change (RVFAC) [(42.51±6.30)% vs. (36.84±5.73)%, t=3.94, P=0.001], left atrial volume index (LAVI) [(28.32±5.45) ml/m² vs. (34.22±6.13) ml/m^2, t=4.08, P=0.001], and systolic pulmonary artery pressure (sPAP) [(36.71±6.14) mmHg vs. (42.30±5.81) mmHg, t=3.57, P=0.001]. The forced expiratory volume in one second (FEV₁)% [(72.52±7.15)% vs. (65.41±6.90)%, t=4.15, P=0.001], FEV₁/FVC ratio [(62.43±6.31)% vs. (58.94±5.82)%, t=2.38, P=0.021], and peak expiratory flow (PEF) [(4.25±0.83)L/s vs. (3.50±0.72)L/s, t=3.76, P=0.001] were significantly higher in the observation group, while the modified Medical Research Council (mMRC) dyspnea score [(1.34±0.53) vs. (1.81±0.60), t=3.52, P=0.001] was significantly lower. The changes in the six-minute walk test (6MWT) distance [(105.0±38.4)m vs. (50.1±29.8)m, t=5.92, P<0.001] and NT-proBNP level [(-769.8±245.4) pg/ml vs. (-365.0±198.9)pg/ml, t=6.28, P<0.001] were also superior in the observation group. In the observation group, treatment was effective in 25 cases (89.29%) and adverse events occurred in 3 cases (10.71%), whereas in the control group, treatment was effective in 21 cases (68.97%) and adverse events occurred in 8 cases (27.58%) (P<0.05).

Integrated stepwise respiratory rehabilitation training based on the cardiopulmonary interaction mechanism can improve postoperative cardiopulmonary function, exercise tolerance, and clinical prognosis while reducing the incidence of adverse events in patients with AD complicated with COPD, demonstrating significant clinical value.