多学科合作团队在慢性阻塞性肺疾病患者全程康复护理过程中的作用研究

Study on the Role of the Multidisciplinary Team in the Course of Rehabilitation and Nursing for COPD Patients from Hospital to Community

目的探讨多学科合作团队在慢性阻塞性肺疾病(COPD)患者从医院到社区全程康复护理过程中的作用。方法 2010年6月—2011年10月将120例COPD患者分为康复组与对照组,每组含Ⅱ、Ⅲ、Ⅳ级COPD患者各20例。康复组采用多学科合作团队工作方案实施院内综合康复护理和社区跟踪康复指导,对照组采用呼吸科常规治疗护理。分别收集两组患者入院时、出院3个月、6个月及12个月的BODE指数〔体质指数(BMI,B)、气流阻塞程度(O)、呼吸困难程度(D)、运动能力(E)〕、St George's呼吸问卷(SGRQ)、焦虑自评量表(SAS)及抑郁自评量表(SDS)评分、1年内平均住院日、平均医疗费、再次入院次数进行效果评价。结果入院时两组患者的SGRQ总分、呼吸症状、活动受限及疾病影响得分比较差异均无统计学意义(P>0.05)。两组患者出院3个月时的BODE指数、体质指数(BMI)、第1秒用力肺活量占预计值百分比(FEV1%pred)差异均无统计学意义(P>0.05)。出院6个月及12个月时康复组BODE指数、呼吸困难量表(MMRC)低于对照组,BMI、6 min步行距离(6MWD)高于对照组,出院12个月时康复组的FEV1%pred高于对照组,差异有统计学意义(P<0.05)。出院6个月及12个月时SGRQ、SAS及SDS评分及1年内平均住院日、平均医疗费、再次入院次数均低于对照组,差异有统计学意义(P<0.05)。结论多学科合作团队能有效提高COPD患者的运动耐力和生存质量,减轻患者的心理负担,缩短平均住院日,降低平均医疗费及再次入院次数,节约医疗卫生资源。

Objective To study the role of the muhidisciplinary team in the course of rehabilitation and nursing from hospital to community of COPD patients. Methods A total of 120 COPD patients from June 2010 to October 2011 were divided into the rehabilitation group and the control group, each group containⅡ , Ⅲ, Ⅳ level COPD patients and the number of every level is 20 cases. The rehabilitation group patients received hospital comprehensive rehabilitation and nursing measures and com- munity tracking rehabilitation guidance by using the work plan of the multidisciplinary team. The control group received conven- tional treatment and nursing of respiratory medicine. When the two groups were admitted to hospital, at 3 months, 6 months and 12 months after admission, the data such as the BODE index （body mass index, airflow obstruction, dyspnea, and exercise ca- pacity index）, SGRQ, SAS and SDS score, annual average days of hospitalization, annual average medicalcharge, annual times of readmission to hospital were collected and analysed for curative effect evaluation. Results When the two groups were admitted to hospital, there was no significant difference in SGRQ score, symptoms in respiratory system, activity limitation and disease in- fluence score. At 3 months after admission, there was no significant difference in the total BODE, BMI and FEV1%pred （P 〉 0. 05 ）. At 6 months and 12 months after admission, BODE index and MMRC in rehabilitation group were significantly lower than those in the control group, BMI and 6MWD in rehabilitation group were significantly higher than those in the control group; at 12months after admission, FEVI % Pred in rehabilitation group was significantly higher than that in the control group （P 〈 0. 05 ）. At 6 months and 12 months after admission, SGRQ, SAS and SDS score, annum average days of hospitalization, annual average medical charge, annum times of readmission to hospital were significantly lower than those in the control group （ P 〈 0.05 ）. Conclusion The multidisciplinary team can effectively improve the exercise tolerance and the quality of life of patients with COPD, alleviate the psychological burden, shorten the average days of hospitalization, and reduce average medical charge and the times of readmission to hospital, thus the medical and health resources were economized.