集中护理模式对于提高COPD患者吸入制剂使用正确率、肺功能和减少再入院风险的价值

Effects of Centralized Nursing Model on the Enhancing the Accuracy of Inhaled Formulations, Pulmonary Function, and Reducing the Risk of Re-admission in COPD Patients

目的探究慢性阻塞性肺疾病(chronic obstructive pulmonary,COPD)患者应用集中护理模式对于吸入制剂使用、肺功能和再入院的影响。方法选择2016年1月至2016年4月来四川省成都市第三人民医院就诊的COPD患者102例,随机数字表法分为对照组和实验组,每组51例,在常规治疗的基础上,对照组和对照组分别给予常规护理与集中护理模式,院外随访12个月。比较2组比较护理前后的吸入制剂使用评分和正确率、治疗依从性(MASES评分)、肺功能指标、症状评分(mMRC评分)、活动能力(6MWT)和生活质量(SGRQ评分),绘制生存曲线,比较2组患者AECOPD和再入院的发生风险。结果与护理前相比,2组患者的吸入剂使用评分和正确率以及MASES评分均明显升高(P <0.05),其中,实验组的吸入剂使用评分和正确率以及MASES评分均显著高于对照组(t/χ^2=3.977, 14.294,6.307, P=0.000,0.000,0.000)。护理后2组的FEV1%Pred和FVC%Pred均明显高于护理前(P <0.05),对照组护理后的TLC和RV/TLC明显升高(P <0.05),而实验组无明显变化(P> 0.05);实验组的FEV1%pred和FVC%Pred明显高于对照组(t=2.010, 2.045,P=0.047,0.044),而TLC和RV/TLC明显低于对照组(t=2.317,2.685,P=0.023,0.008)。护理前,2组的mMRC评分、6MWT和SGRQ评分均差异无统计学意义(P> 0.05);护理后,2组的mMRC评分以及SGRQ评分明显降低(P <0.05),6MWT显著升高(P <0.05),其中,实验组的mMRC和SGRQ评分明显低于对照组(t=2.439, 2.161,P=0.016,0.033),6MWT明显高于对照组(t=2.441,P=0.016)。对照组和实验组在出院后12个月内的AECOPD发作率分别为78.43%(40/51)和62.75%(32/51),实验组的AECOPD发作风险明显低于对照组[HR=0.560,95%CI (0.350~0.895),P=0.001];对照组和实验组出院后12个月的再入院率分别为62.75%(32/51)和47.06%(24/51),实验组的再入院风险明显低于对照组[HR=0.582,95%CI (0.343~0.986),P=0.032]。结论集中护理模式可以有效提高COPD患者吸入制剂使用的正确率和依从性,明显改善症状和肺功能指标,显著增强活动能力和生活质量并降低AECOPD和再入院的发生风险。

Objective To investigate the effects of concentrated nursing model on the enhancing the accuracy of inhaled formulations, pulmonary function, and reducing the risk of re-admission in COPD patients. Methods A total of 102 patients with COPD who visited our hospital from January 2016 to April 2016 were randomly divided into control group(51 cases) and experimental group(51 cases). The control group and the experimental group were treated by conventional and centralized nursing model,respectively and all were followed up for 12 months. The scores and accuracy of inhaled preparations, treatment compliance, lung function indicators, symptom scores,activities and quality of life were compared between the two groups before and after nursing. The survival curves were plotted and the risk of AECOPD and readmission was compared between the two groups. Results Compared with pre-care, the scores of inhalant use and accuracy as well as MASES scores were significantly higher in the two groups 12 months later(P < 0.05). Among them, the scores of inhalant use and accuracy as well as MASES scores were significantly higher in the experimental group than those of control group(t/χ^2=3.977, 14.294, 6.307, P= 0.000, 0.000, 0.000). The FEV1%pred and FVC%pred were significantly increased after nursing in both groups(P < 0.05). After nursing, the TLC and RV/TLC increasedobviously in control group(P < 0.05), but not in the experimental group(P > 0.05). The levels of FEV1 and FVC% pred in the experimental group were significantly higher when compared with control group(t= 2.010, 2.045,P = 0.047, 0.044), while TLC and RV/TLC were significantly lower than the control group(t=2.317, 2.685,P = 0.023, 0.008). Both m MRC and SGRQ scores after nursing were significantly lower, while the 6 MWT was obviously higher than those before nursing(P < 0.05). Among them, the m MRC and SGRQ scores in experimental group were lower(t=2.439, 2.161, P= 0.016, 0.033), and the 6 MWT was higher when compared with the control group(t=2.441, P = 0.016). The incidence of AECOPD after discharge was 78.43% and 62.75% in the control group and experimental group. The in the experimental group has a lower risk of AECOPD(HR=0.560, 95% CI [0.350, 0.895],P = 0.001);the readmission rate 12 months after discharge of the control and experimental groups were 62.75% and 47.06%, and the experimental group had a lower risk of readmission(HR=0.582, 95% CI [0.343, 0.986], P = 0.032).Conclusions The centralized nursing model can effectively improve the accuracy and compliance of inhaled preparations for patients with COPD, significantly improve the symptoms and lung function of patients with COPD,significantly enhance mobility and quality of life, and reduce the risk of AECOPD and re-admission.