义诊在轻中度呼吸困难管理中的应用探讨

A discussion on the application of volunteer clinic for respiratory disease in mild and intermediate dyspnea management

目的探讨呼吸疾病义诊形式在轻中度呼吸困难管理中的价值及相关资料分析。方法借助“世界哮喘日”与“世界COPD日”集中宣教契机，组织呼吸疾病义诊，服务轻中度呼吸困难人群并收集近5年来参加义诊者556人次的临床资料，包括年龄、体质量指数（BMI）、吸烟指数、肺功能（FVC％pred、FEV1％pred）、血压、心率、血氧饱和度、心率血压乘积（rate-pressure product，RPP）等，应用SPSS软件进行统计分析。结果肺通气功能不全比例69．78％，以混合性通气功能障碍表现为主，FEV1％pred中重度减退者可达45．10％；除BMI和心率外，其他指标均呈现出性别差异，即女性组FEV1％pred、FVC％pred（t值分别为2．244、2．459，P值均〈0．05）及SPO2（Z=3．665，P〈0.01）高于男性组，差异有统计学意义；男性组年龄、收缩压、舒张压、吸烟指数显著高于女性组（Z值分别为-3．903、-2．969、-2．742、-11．481，P值均〈0．01）；女性组RPP与FEV1％pred呈负相关（r=-0．134，P〈0．05），与FVC％pred呈显著负相关（r=-0．168，P〈0．01）；而男性组RPP与FVC％pred、FEV1％pred均无明显相关性（r值分别为-0．102、-0．066，P值均〉0.05）。结论在近阶段尚无就医计划的轻中度呼吸困难人群管理中要重视性别差异，采用呼吸疾病义诊形式进行健康宣教，可使相应群体获益。

Objective To evaluate the application of volunteer clinic for respiratory disease in mild and intermediate dyspnea management and analyze corresponding data material. Methods A volunteer clinic for respiratory disease, aiming at population with mild and intermediate dyspnea, was organized every year by virtue of propaganda for World Asthma Day and World chronic obstructive pulmonary disease （COPD） Day. A total of 556 people have been served and corresponding clinical data material was collected, which included age, bodyweight index （BMI）, smoking index, pulmonary function （FVC%pred, FEV1% pred）, blood pressure, heart rate, degree of blood oxygen saturation, rate-pressure product （RPP）, etc. 8PSS was used to analyze the data. Results The proportion of pulmonary ventilation insufficiency was 69.78%, the majority of which was mixed ventilation dysfunction. The proportion of intermediate/severe decline in FEV1 was 45.10%. There was gender difference in all the index but BMI and HR, which indicated significantly higher FEV1% pred, FVC% pred （ t = 2.244,2. 459, all P〈0.05） and SPO2 （ Z = -3. 665, P〈0.01） in female patients and significantly higher age, systolic pressure, diastolic pressure, smoking index （Z=-3.903,-2.969,-2.742,-11.481,all P 〈0.01） in male patients. There was negative association between RPP and FEV1 %pred （ r = -0. 134, P〈0.05） and that between RPP and FVC%pred （r =-0.168, P （0.01） in male patients. No such negative association （r values were -0. 102,-0. 066, all P〉0.05） was found in male patients. Conclusions Gender difference should be emphasized with regarding to the management of population with dyspnea who do not yet to see a doctor in the near future. The relating population can benefit from volunteer propaganda for respiratory disease.