基于老年综合评估的综合护理干预对老年慢性阻塞性肺疾病患者康复过程中生命质量及肺功能的影响

The effect of comprehensive nursing intervention based on Comprehensive Geriatric Assessment on the life quality and pulmonary function in the rehabilitation of old patients with chronic obstructive pulmonary disease

目的 探讨基于老年综合评估（CGA）的综合护理干预对老年慢性阻塞性肺疾病（COPD）患者康复过程中生命质量及肺功能的影响.方法 选取2013年12月至2016年12月收治的COPD患者70例,采用随机数字表法分为对照组和CGA组,每组35例.对照给予常规护理干预,CGA组给予基于CGA评估的综合护理干预.比较2组患者干预前后肺功能以及生命质量的变化状况.结果 干预前,2组患者的生命质量各维度（日常生活、社会活动、焦虑症状、抑郁症状）得分比较差异无统计学意义（P〉0.05）;干预后,2组患者的生命质量各维度得分与干预前比较均有显著降低,且CGA组的生命质量各维度得分降低幅度显著高于对照组：（1.81±0.21）分比（2.61±0.17）分,（1.51±0.29）分比（1.97±0.34）分,（1.72±0.32）分比（2.29±0.37）分,（1.91±0.23）分比（2.86±0.48）分,差异均有统计学意义（t=6.0898～17.5171,P〈0.05）.干预前,2组患者的肺功能各指标,如用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、呼气峰值流速以及FEV1/FVC比较差异无统计学意义（P〉0.05）;干预后,2组患者的肺功能各指标与干预前比较均有显著改善,且CGA组的肺功能各指标的改善程度显著优于对照组：（2.80±0.41）L比（2.24±0.31）L,（1.98±0.24）L比（1.50±0.21）L,（70.31±10.21）％比（61.50±8.92）％,（4.49±0.28）％比（3.75±0.39）％,差异均有统计学意义（t=3.8444～9.1186,P〈0.05）.结论 基于CGA的综合护理干预,可有效提升COPD患者肺功能,改善患者的生命质量,缓解患者焦虑、抑郁情绪,提高护理干预效果,值得在临床中推广应用.

Objective To discuss the effect of comprehensive nursing intervention based on Comprehensive Geriatric Assessment （CGA） on the quality of life and pulmonary function in the rehabilitation of old patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 70 cases of COPD patients admitted from December 2013 to December 2016 in our hospital were randomly divided into the control group and CGA group, 35 cases in each group. The control group received routine nursing intervention, while the CGA group received comprehensive nursing intervention based on CGA assessment. The improvement of lung function and quality of life before and after nursing intervention was compared between the two groups. Results Before nursing intervention, the patients in CGA group and the control group showed no statistical significance in scores of each dimension of quality of life, such as daily life, social activities, anxiety, depression （P 〉 0.05）. After nursing intervention, scores of each dimension of quality of life were significantly lower compared with before nursing intervention, and the quality of life score in CGA group were significantly higher than those of the control group： 1.81±0.21 vs.2.61±0.17, 1.51±0.29 vs. 1.97±0.34, 1.72±0.32 vs. 2.29±0.37, 1.91±0.23 vs. 2.86±0.48, each dimension score lower amplitude differences all had statistical significance（t=6.0898-17.5171, P〈0.05）. Nursing intervention before the CGA group of patients with the control group in patients with various lung function index [forced expiratory lung live（FVC）, forced expiratory value 1 second（FEV1）, peak expiratory flow and FEV1/ FVC] to compare differences had no statistical significance （P 〉 0.05）. After nursing intervention, two groups of patients with the lung function of each index were significantly improved compared with before nursing intervention, the index of lung function and CGA group improved significantly better than control group：（2.80 ± 0.41）L vs.（2.24 ± 0.31）L,（1.98 ± 0.24）L vs.（1.50 ± 0.21）L, （70.31±10.21）%vs.（61.50±8.92）%,（4.49±0.28）%vs.（3.75±0.39）%, the differences were statistically significant（t=3.8444-9.1186, P〈0.05）. Conclusions Comprehensive nursing intervention based on CGA can effectively improve the pulmonary function of patients with COPD, improve the quality of life of patients, relieve anxiety and depression, and improve the effect of nursing intervention. It is worth popularizing in clinical practice.