慢性阻塞性肺疾病患者接受长期管理48例随访结果分析

A follow-up study on 48 patients with chronic obstructive pulmonary disease by long-term management

目的 寻求一种能够减轻慢性阻塞性肺疾病 (COPD)患者症状 ,尽可能减缓其肺功能下降速度 ,改善生命质量的方法。方法 入选的 4 8例患者先填写患者登记表 ,考核对COPD的认识水平和生命质量。然后举办简短的学习班 ,与入选患者共同制订基本药物治疗方案以及康复锻炼计划 ,帮助其中吸烟者制订戒烟计划 ,并要求每位患者记录防治疾病日记。此后每 2个月随访复查 1次 ,由患者汇报病情变化情况、治疗和康复锻炼情况 ,并根据病情变化调整用药方案。研究结束时对患者进行一次考核 ,内容方法与入选时相同。结果 经过系统教育、规范治疗辅以康复锻炼 ,4 8例COPD患者咳嗽、咳痰、气短评分显著降低 (均P <0 0 0 1 ) ,门诊就诊次数由入选前 ( 6± 5 )次 /年减少为 ( 3± 3 )次 /年 (P <0 0 0 1 ) ,1秒钟用力呼气容积占预计值百分比显著改善 ,由入选时 ( 62± 2 7) %增加至 ( 69± 3 1 ) %(P <0 0 0 1 ) ,生命质量评分也由入选时 1 1 3± 1 2升高至 1 1 8± 1 2 (P <0 0 5 ) ,相关疾病知识由入选时 ( 1 1± 4 )分提高至 ( 1 5± 5 )分 (P <0 0 0 1 )。两年中 1 4名吸烟者中 6人成功戒烟 1年以上。同时显示COPD患者对本病认识水平也有显著提高。结论 对COPD患者进行系统的教育、管理和规范治疗 ,辅以必要的康复?

Objective To find an effective approach to control symptoms in patients with chronic obstructive pulmonary disease (COPD) and slowdown decrease in their pulmonary function and improve their quality of life Methods Totally, 48 patients were enrolled and a registration form was filled out by each at the beginning of the study to evaluate their understanding on COPD itself and their quality of life Afterwards, a short-term study course was held to help patients draw a multimodality plan, including basic medication and pulmonary rehabilitation and exercise training program Current smokers were advised to quit All patients were required to diarize everyday about their frequencies and variations of symptom and hospital visit Follow-up was carried out every two months for two years During the follow-up, patients reported their situations of illness, medication, rehabilitation and exercise progressed Therapeutic regimens were adjusted according to their status of illness At the end of the study, patients were assessed again the same way as that at the beginning Results After receiving systematic education and standardized therapy, supplemented with rehabilitation exercise program, scores of cough, expectoration and dyspnea in 48 patients reduced significantly, P <0 001 Frequency of hospital visit decreased from (6±5) to (3±3) visits per year ( P <0 001) Forced expiratory volume in one second (FEV 1) improved greatly from (62±27) % to (69±31) % of the predicted volume ( P <0 001) Quality of life improved from (113±12) to (118±12) scores ( P <0 05) Awareness of COPD-related-knowledge increased from (11±4) to (15±5) scroes ( P <0 001) During the past two years, six of fourteen smokers had abstained themselves from smoking successfully for more than one year Conclusions Multimodality approach, consisting of systematic education and management, standardized therapy and pulmonary rehabilitation exercise program, was effective to alleviate symptoms in patients with COPD, improve their impaired pulmonary function, reduce frequency of hospital visit, and improve their quality of life