尘肺病并发慢性阻塞性肺疾病患者稳定期用药依从性调查

Investigation of medication compliance in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease at stable stage

目的调查尘肺病并发慢性阻塞性肺疾病(COPD)患者稳定期吸入剂用药依从性并探讨影响依从性的因素.方法选取2016年12月至2017年8月在湖南省职业病防治院职业病四科住院的尘肺病合并COPD的患者为研究对象,共158例.完善胸片、胸部高分辨CT(HRCT)、肺功能检查,并进行CAT评分及MRC评分,收集其年龄、文化、吸烟史、1年急性加重情况、购买医疗保险等情况,并在6个月后进行随访.将成功随访的1 15例患者分为未坚持用药组及坚持用药组,比较其年龄、文化得分、吸烟情况.结果成功随访的115例患者中,坚持用药14例(12.17%),未坚持用药101例(87.83%).未坚持用药组吸烟指数中位数为30(15,40),坚持用药组为16(6,31),坚持用药组吸烟指数低于未坚持用药组,但差异无统计学意义(P>0.05).未坚持用药组和坚持用药组FEV1%分别为44.69±15.48、37.12±16.98;未坚持用药组和坚持用药组FEV1/FVC分别为52.43±9.19、44.43±11.88,坚持用药组肺功能比未坚持用药组差.COPD分级中,D级的坚持用药率高于A、B、C级,其中D级与B级差异有统计学意义(P<0.05).尘肺叁期坚持用药率高于尘肺贰期及尘肺壹期组.工伤医疗保险尘肺患者较新农合医疗保险尘肺患者治疗依从性高.结论尘肺病并发COPD患者稳定期吸入剂用药依从性低,肺功能越差的患者长期吸入剂使用依从性越高,工伤尘肺患者较新农合尘肺患者治疗依从性高.

Objective To investigate the compliance of inhalation during stable phase of pneumoconiosis complicated with COPD and to explore the factors influencing compliance.Methods The patients with pneumoconiosis complicated with COPD who were hospitalized in the four Department of occupational disease prevention and treatment in Hunan province from December 2016 to August 2017 were selected as the research subjects.The examination of Chest radiograph,HRCT and lung function was perfected,and CAT score and MRC score were carried out.The age,culture,smoking history,acute aggravation of 1 years,medical insurance and so on were collected,and follow-up was conducted after 6 months.Results Of the 115 patients who had successfully followed up,14 cases (12.17%) were persisted in medication,and 101 cases (87.83%) did not adhere to the medication.The smoking index median of the non adherence group was 30 (15,40),while that of the adherence group was 16 (6,31).The smoking index of the adherence group was lower than that of the non adherence group.The FEV1% in the unadhered group was 44.69+15.48,and the drug group was 37.12+16.98,the FEV1/FVC in the unadhered group was 52.43+9.19,and the drug group was 44.43+11.88,and the lung function of the drug group was worse than that of the unadhered group.The adherence rate of group COPD(group D) was higher than that of group A,B and C,and the difference between D group and B group was statistically significant.The adherence rate of pneumoconiosis stage Ⅲ was higher than that of pneumoconiosis stage Ⅱ and pneumoconiosis Ⅰ.Conclusion The compliance of long acting bronchodilator inhalation is low in stable phase of pneumoconiosis complicated with COPD.The poorer the lung function,the higher the compliance of inhalation.The compliance of pneumoconiosis patients with Medical insurance for industrial injury is higher than that of pneumoconiosis patients with New rural cooperative medical service.