COPD患者随访依从性及其相关因素研究

Research on Follow-up Compliance and Related Factors in COPD Patients

目的分析COPD患者的随访依从性,探讨随访依从性的相关影响因素。方法收录2008年12月—2012年10月就诊于承德医学院附属医院呼吸科的456例COPD患者,对吸烟患者实施医生"劝导戒烟干预";所有患者在进行常规治疗的同时每隔3个月对其进行随访,为期1年。记录COPD患者纳入时和随访满1年时1年内急性加重次数和呼吸困难评分;计算患者随访依从率。结果随访时间满1年时,总体随访依从率为83.3%(380/456)。男性COPD患者随访依从率高于女性(P<0.05);不同文化程度、不同肺功能分级COPD患者随访依从率比较,差异有统计学意义(P<0.05);吸烟COPD患者随访依从率高于非吸烟患者,差异有统计学意义(P<0.05)。失访的76例COPD患者中,因近期自我感觉良好或经济原因拒绝复查28例(36.8%),因家远不能按时随访15例(19.8%),因更换电话号码、错号、公用电话或拒接电话等联系不上14例(18.4%),死于肺部疾病13例(17.1%),死于其他疾病4例(5.3%),随访期间因卧床不能配合肺功能检查2例(2.6%)。随访依从性差组170例(37.3%),依从性好组286例(62.7%)。依从性好组和依从性差组1年内急性加重次数、呼吸困难评分在纳入时和随访满1年时比较,差异均有统计学意义(P<0.05)。依从性好组随访1年时1年内急性加重次数、呼吸困难评分均低于依从性差组(P<0.05);依从性好组1年内急性加重变化量、呼吸困难评分变化量均低于依从性差组(P<0.05)。结论性别、文化程度及疾病严重程度对COPD患者随访依从性均有影响,且随访依从性差异可影响患者的疾病急性加重频率和临床症状,为今后研究提供了参考依据。

Objective To analyze the follow- up compliance of COPD patients,and explore the related influencing factors. Methods 456 COPD patients who visited the Affiliated Hospital of Chengde Medical College from December 2008 to October 2012 were included in the study. All patients received convention treatment and smoking patients received extra smoking cessation advice. At the same time,all of the subjects received 1 year’s follow- up once every 3 months. This study recorded the times of exacerbation and dyspnea score at the time on inclusion,within follow- up and after follow- up and calculated patients’ follow- up compliance. Results After follow- up,the overall compliance rate was 83. 3%（ 380 /456）,the compliance rate of males was higher than that of female and the difference was significant（ P 〈 0. 05）. The differences between patients with different educational level and with different grade of pulmonary function were significant（ P 〈 0. 05）. The compliance rate of smoking patents was higher than that of non- smoking patients and the difference was significant（ P 〈 0. 05）. Among the 76 patients with lost of follow up,28（ 36. 8%） refused follow- up because of feeling well recently or financial situation; 15（ 19. 8%） didn’t accept follow-up on time because of long distance from home; 14（ 18.4%） could not be contacted because of number change,wrong number,public phone or refusal of answering calls; 13（ 17. 1%） died of lung disease; 4（ 5. 3%）died of other diseases; 2（ 2. 6%） could not have lung examination for being confined to bed because of illness. In all,there were 170（ 37. 3%） in bad follow- up compliance group and 286（ 62. 7%） in good follow- up compliance group. The differences of times of exacerbation during the following- up period and dyspnea score on inclusion and after follow- up between the two groups were significant（ P 〈 0. 05） and those and the variable quality in good compliance group were all lower than those and the variable quality in bad compliance group and all the differences were significant（ P 〈 0. 05）. Conclusion Gender,educational background and the degree of severity of the disease are the influencing factors for the compliance of patients with COPD,and the follow- up compliance has an effect on frequency of exacerbation and clinical symptoms.