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.