患有慢性阻塞性肺疾病的老年军人330例生活质量现状调查

Quality of life in retired cadres with chronic obstructive pulmonary diseases:Current investigation of 330 cases

目的:调查慢性阻塞性肺疾病老年军人的生活质量、病情严重程度、肺功能分级及治疗情况。方法:①于2004-04/09对以往确诊为慢性阻塞性肺疾病的定居成都市24个干休所师以上离休干部330例进行调查,均为男性,年龄70～87岁。均符合中华医学会呼吸病学分会慢性阻塞性肺疾病诊治规范,且对调查和检查项目知情同意。②采用自拟生活质量问卷调查(呼吸症状、活动受限、疾病影响、经济状况)纳入对象生活质量,该问卷共计0～100分,分值越低代表慢性阻塞性肺疾病患者的健康状况越好,≥40分为生活质量较差,≥70分为生活质量极差。进行血气分析(动脉血氧分压、二氧化碳分压、血氧饱和度)。③采用德国耶格公司的高级组合式肺功能仪(Masterscreen系列)进行通气功能检查,包括第1秒用力呼气量占预计值的百分比、每分钟最大通气量实测值占预计值的百分比。④慢性阻塞性肺疾病分级:Ⅰ级(轻度):第1秒用力呼气量占预计值的百分比≥70%;Ⅱ级(中度):第1秒用力呼气量占预计值的百分比为50%～69%;Ⅲ级(重度):第1秒用力呼气量占预计值的百分比<50%。⑤肺功能分级:基本正常:每分钟最大通气量实测值占预计值的百分比>81%,第1秒用力呼气量占预计值的百分比>71%,血氧饱和度>94%,氧分压>11.57kPa,二氧化碳分压<5.99kPa;轻度减退:前述5项指标分别为71%～80%,61%～70%,>94%,>11.57kPa,<5.99kPa;显著减退:分别为51%～70%,41%～60%,90%～93%,9.98～11.57kPa,<5.99kPa;严重减退:分别为21%～50%,≤40%,82%～89%,7.98～9.97kPa,>7.99kPa;呼吸衰竭(除外第1秒用力呼气量占预计值的百分比):分别为<20%,<82%,<7.98kPa,>7.99kPa。结果:①吸烟史及合并症:纳入对象吸烟史30～60年,93.6%每年吸烟量≥400支。88.8%合并其他疾病。②生活质量比较差78例(23.6%),生活质量极差9例(2.7%)。③慢性阻塞性肺疾病分级:Ⅰ级65例(19.7%),Ⅱ级166例(50.3%),Ⅲ级99例(30%)。④肺功能:基本正常0例,轻度减退151例(45.8%),显著减退138例(41.8%),严重减退39例(11.8%),呼吸衰竭2例(0.6%)。⑤治疗情况:需长期用药及家庭氧疗的39例(11.8%),需长期住院的9例(2.7%)。每年住院天数≥100d48例(14.6%),<100d,≥30d51例(15.5%)。⑥发病年龄:50～59岁发病118例(35.8%),60～69岁发病184例(55.8%),70～79岁发病28例(8.5%)。结论:慢性阻塞性肺疾病老年军人有长期大量吸烟史,且合并其他疾病;发病年龄集中在50～69岁;生活质量差、肺功能严重减退、需长期住院治疗的占小部分。

AIM： To study the quality of life （QOL）, lesion severity, grade of pulmonary function and treatment of elderly retired cadres with chronic obstructive pulmonary diseases （COPD）. METHODS： （1）A total of 330 male retried cadres above division living in Army Cadre Leaving Office Sanatorium of Chengdu were investigated from April to September in 2004. They, aging 70-87 years, were previously diagnosed as COPD according to the diagnosis and treatment criterion of COPD Unit of Chinese Medical Association Respiratory Branch, and were informed of detection items with consents. （2） All patients received investigation of QOL by questionnaire including respiratory symptom,activity limitation, effect of disease and financial condition, totally 100 scores. The lower score indicated the better health condition of COPD patients, and above or equal to 40 points meant relatively bad QOL while above or equal to 70 points meant extremely bad QOL. Meanwhile, bloodgas analysis was conducted, composing partial pressure of oxygen of arterial blood （PaO2）, partial pressure of carbon dioxide （Pco2） and blood oxygen saturation （SaO2）.（3）Ventilation function was tested with a diagnostic system （MasterScreen^TM. E. Jaeger. Wuerzburg, Germany）, and consisted of the ratio of forced expiratory volume in the first second （FEV1）/predictive value （PV） and the ratio of measured value/PV of maximal voluntary ventilation （MVV）.（4）Grade of COPD： I （gentle）： ratio of FEVI/PV ≥ 70%; Ⅱ （moderate）： ratio of FEV1/PV was between 50% and 69%; Ⅲ （severe）： ratio of FEV1/PV 〈 50%.（5）Grade of pulmonary function： Normal： ratio of MVV/PV 〉 81%, FEV1/PV 〉 71%, SaO2 〉 94%, PaO2 〉 11.57 kPa, and Pco2 〈 5.99 kPa; Gently drop： The former five indexes were 71%- 80%, 61%-70%, 〉 94%, 〉 11.57 kPa, 〈 5.99 kPa, respectively; Markedly drop： The former five indexes were 51%-70%, 41%-60%, 90%-93%, 9.98-11.57 kPa, 〈 5.99 kPa, respectively; Severely drop： The former five indexes were 21%-50%,≤ 40%, 82%-89%, 7.98-9.97 kPa, 〉 7.99 kPa, respectively; Respiratory failure： The four indexes （except ratio of FEV1 /PV） were 〈 20%, 〈 82%, 〈 7.98 kPa, 〉 7.99 kPa, separately. RESULTS：（1）History of smoking and complication： All the subjects had the history of smoking for 30-60 years, thereinfo 93.6% of them smoked over 400 cigarettes every year and 88.8% of COPD patients suffered from complications.（2）QOL was relatively bad in 78 cases （23.6%） and extremely bad in 9 cases （2.7%）.（3）Grade of COPD： Ⅰ grade in 65 cases （19.7%）, Ⅱgrade in 166 cases （50.3%）, Ⅲ grade in 99 cases （30%）. （4）Pulmonary function： normal in 0 case, gently drop in 151 cases （45.8%）, markedly drop in 138 cases （41.8%）, severely drop in 39 cases （11.8%）, respiratory failure in 2 cases （0.6%）. @Treatment： There were 39 cases in need of continuous medication and oxygen therapy in family （11.8%） and 9 cases demanding long-term hospitalization （2.7%）. On average, the patients stayed, in hospitals for over 100 days in 48 cases （14.6%） and for 30-100 days in 51 cases （15.5%）.（6）Patient＇s age when onset was between 50 and 59 years in 118 cases （35.8%）, between 60 and 69 years in 184 cases （55.8%） and between 70 and 79 years in 28 cases （8.5%）. CONCLUSION： Smoking is mostly dangerous for COPD patients, accompanying other complications. Age of incidence is mostly between 50 and 69 years. The patients with bad QOL,. severely declined pulmonary function and in need of long-term hospitalization account for a small number of retired cadre of COPD.