慢性閉塞性肺疾患患者の運動耐容能・肺機能に対する温熱療法の有効性についての検討　－pilot study－

我々は現在まで, 慢性閉塞性肺疾患(COPD；chronic obstructive pulmonary disease)患者に対する複合温泉療法(温泉プール運動浴, 鉱泥湿布療法, ヨード吸入) の有効性を報告してきた｡今回, 温熱療法の有効性を明らかにすることを目的として, 温熱療法を 従来の治療に併用し, 運動耐容能および肺機能に対する効果を検討した｡Ａ群７例(68～79歳・男性６例, 女性１例) およびＢ群７例(63～81歳・全例男性), 計14例のCOPD患者を対象とした｡Ａ群については, 薬物・肺理学療法の他に, 温熱療法を週５回で４週間施行した｡ 温熱療法として, 乾式遠赤外線式サウナを用いた60℃, 15分間のサウナ浴(座位) を施行した後, 臥位で30分間全身を毛布で包んで安静保温した｡Ｂ群は, 薬物・肺理学療法のみ４週 続けた｡治療前後で肺機能および６分間歩行試験を施行し比較検討した｡両群とも, 治療開始４週後には６分間歩行での歩行距離, 酸素飽和度(ＳpO2), 修正Borg scaleにて改善を認め, 肺機能においても肺活量(VC；vital capacity), 一秒量(FEV1.0；forced expiratory volume in one second) は上昇した｡両群間の比較では, ６分間歩行試験で上記３項目の改善率はいずれもＡ群はＢ群を凌駕し, Ａ群が優位に運動耐容能の向上を認めた｡Ａ群で修正 Borg scaleの治療４週間後の改善率は有意差(p＜0.01) を認めた｡また肺機能では, ４週間後でVC上昇率はほぼ不変であったがFEV1.0ではＡ群が優位に上昇した｡以上の結果より温熱療法がCOPD治療に有効である可能性が示唆された｡

We have reported the effectiveness of the complex spa therapy (swimming training in a hot spring pool, fango therapy, and inhalation of iodine salt solution) for patients with chronic obstructive pulmonary disease (COPD). In present study, we examined the effectiveness of thermal therapy for COPD patients. Fourteen patients with COPD were classified into two groups； group A (６ males and 1 female, 68-81 years) and group B (７ males , 68-81 years) . For group A , we underwent the thermal therapy which warms the whole body in a sitting posture at 60℃ for 15 minutes with dry system farinfrared sauna 5 times a week, in addition to medication therapy and lung physiotherapy. On the other hand, we carried out only medication therapy and lung physiotherapy for group B. All subjects were treated for 4 weeks. The pulmonary function test and 6 minute-walk test were performed before and after these therapies. In the pulmonary function test, vital capacity (VC) and forced expiratory volume in one second (FEV1) after the therapy improved more than those before therapy in both A and B groups. The FEV1 value after 4 weeks tended to increase more in group A compared with group B. However, no changes were observed in the VC value. In 6 minute-walk test, distance value, oxygen saturation value and Borg Scale value improved more than those before therapy in both A and B groups. These three parameters after 4 weeks tended to improve more in group A compared with group B. In particular, the statistically significant difference was observed in Borg Scale value before and after therapy (p<0.01). It is suggested that the thermal therapy could improve pulmonary function and exercise tolerance, and be helpful in the therapy of COPD patients.