社区健康管理对老年慢性喘息性支气管炎肺功能及预后的影响

Effect of community health management on the pulmonary function and prognosis of elderly patients with chronic asthmatic bronchitis

目的探讨社区健康管理对老年慢性喘息性支气管炎患者肺功能及预后的影响。方法选择社区老年慢性喘息性支气管炎患者268例,随机分成观察组和对照组。基线调查后,对照组(130例)予以门诊常规治疗,观察组(138例)进行社区健康管理,2组患者干预时间均为12个月。采用t检验比较基线资料与社区健康管理实施后2组患者肺功能及预后情况,多因素logistic回归分析找出影响预后的因素。结果 2组患者基线资料差异无统计学意义(P>0.05),随访结束后观察组肺部啰音明显减少(P<0.05),与对照组比较差异有统计学意义(P<0.05);对照组感染发生例数较基线时明显增加(P<0.05),而观察组感染无明显变化(P>0.05)。第6、9及12个月随访时,观察组肺功能较同组基线水平及对照组均有明显改善(P<0.01),而随访结束后对照组肺功能较基线水平明显下降(P<0.05)。观察组喘憋、呼吸困难、肺气肿及肺动脉高压发生率均明显低于对照组(P<0.05)。多因素logistic回归分析结果显示,年龄、感染及二氧化碳分压(Pa CO2)是影响预后的危险因素,而氧分压(Pa O2)、用力肺活量(FVC)、第1秒用力呼气量占预计量计值百分比(FEV1%)及呼气流速峰值(PEF)是预后的保护因素。结论社区健康管理可有效改善老年慢性喘息性支气管炎肺功能,减少并发症发生概率,改善预后,提高老年患者的生活质量。

[Objective]To investigate the influence of community health management on the pulmonary function and prognosis of elderly patients with chronic asthmatic bronchitis. [Methods]Two hundred sixty eight patients with chronic asthmatic bronchitis were randomly divided into the control group and the observation group. After the baseline research, the control group（130 cases）was treated with routine treatment in outpatient department,while the observation group（138 cases）received the community health management for 12 months. T test was applied to compare baseline characters,the pulmonary function and prognosis after treatment for 12 months. Multinomial logistic regression analysis was performed to find out the influence factors of prognosis. [Results]There were no significant differences in baseline characters between the control group and the observation group（P〈0.05）. After follow up,pulmonary rales in observation group were decreased compared with control group（P〈0.05）.Infection of control group obviously increased compared with baseline（P〈0.05）,but the observation group did not（P〈0.05）.Compared with baseline and control group,the pulmonary function in observation group were significantly improved after the sixth and ninth and twelfth month（P〈0.01）,but the pulmonary function in control group were lower than before（P〈0.05）. The rate of wheezing,dyspnea,emphysema and pulmonary hypertension in observation group were markedly descended compared with the control group（P〈0.05）. Multinomial logistic regression analysis showed that age,infection and Pa CO2 were independent risk factors against prognosis,while Pa CO2 and FVC,FEV1% and PEF were protective factors. [Conclusion]The community health management on patients with chronic asthmatic bronchitis can ameliorate pulmonary function, reduce the complications and improve the quality of life.