稳定期慢性阻塞性肺疾病患者短期复诊依从性分析

Compliance analysis on the short-term follow-up in patients with stable chronic obstructive pulmonary disease

目的观察并分析稳定期慢性阻塞性肺疾病患者短期复诊的依从性及其影响因素。方法收集130例患者的一般资料,评估呼吸困难程度、情绪状态和认知功能,测定第一秒呼气量占预计值的百分比(FEV_1%pre)及动脉血气,6个月后评价依从性与各因素的关系。结果完全依从者60例,部分依从者49例,不依从者21例,三者所占比例分别为46.2%、37.7%、16.2%;15个因素中,文化程度、呼吸困难分级、年龄、FEV_1%pre、PaO_2、焦虑得分、抑郁得分、认知评分在不同依从性的患者中存在不同,差异具有统计学意义(P<0.05);相关性分析发现,依从性和年龄、FEV_1%pre、PaO_2、抑郁得分、焦虑得分存在不同程度相关,与抑郁得分相关性最高;文化程度不同,认知评分与FEV_1%pre、PaO_2及负性情绪因素得分的相关性存在不同。有序logistic回归分析所得方程拟合良好,P=0.000,Cox and snell 0.870,Nagelkerke 1.000,Mc Fadden 1.000,拟合度pearsonχ~2=64.774,P=0.000,平行性检验P=1.000;影响因素为氧分压、抑郁得分和认知评分(P<0.05)。结论稳定期慢性阻塞性肺疾病患者短期复诊依从性受多因素影响,氧分压和良好认知功能是保护因素,存在可疑抑郁症状是危险因素,应在工作中予以注意,以期提高依从性。

Objective To observe and analyze the compliance and relevant factors during the short-term fol- low-up in patients with stable COPD. Methods The general data was collected from 130 patients. The degree of dyspnea, emotional state and cognitive function were evaluated respectively. The FEV1 measured/expected value （FEV, % pre） was calculated. PH, PaO2 and PaCO2 were determined through arterial blood gas. The correlation be- tween the compliance and those factors was evaluated after 6 months. Results There were 60 absolutely compliant cases （46. 2% ）, 49 semi-compliant cases （37. 7% ）, and 21 non-compliant cases （16. 2% ）. Among the 15 fac- tors, the degree of education, dyspnea grade, age, FEV1% pre, PaO2, anxiety and depression as well as cognition score were significantly different in the patients with different compliant level （ P 〈 0.05 ）. By correlation analysis, the compliance was related with age, FEV1% pre, PaO2, anxiety and depression score at some extent, while it was closely correlated with depression score. With different education level, the correlation was different between the com- pliance and cognition score, FEVI % pre, PaO2 as well as negative emotion score. The equations from the logistics re- gression analysis could be well fit （ P = 0. 000, Cox and snell = 0. 870, Nagelkerke = 1. 000, McFadden = 1. 000, fit degree pearson %2 = 64. 774, P = 0. 000, congeneric test P = 1. 000）. The influence factors were PaO2, depression score and cognition score （P 〈 0. 05）. Conclusion The compliance on short-term follow-up in patients with stable COPD can be influenced by many factors. PaO2 and good cognitive function are protective factors, and the suspect depressive symptom is the dangerous factor. We should pay more attention to improve the compliance.