规范化管理对降低慢性阻塞性肺疾病患者急性发病风险的影响

The effect of standardized management on reducing the risk of acute exacerbation in patients with chronic obstructive pulmonary disease

目的探讨医院-社区-家庭三位一体规范化管理对慢性阻塞性肺疾病(COPD)患者急性发病风险的影响。方法选取宁波市北仑区人民医院2016年10月至2017年10月确诊的COPD急性加重期(AECOPD)患者82例,出院后均经肺功能检查确诊且处于临床稳定期(C、D级),分为观察组(43例)和对照组(39例)。依照2016 COPD全球倡议(GOLD)治疗指南,对照组患者出院时行家庭宣教指导、药物规范化使用指导及出院后电话随访;观察组患者在此基础上,出院后接受经培训后的社区医生定期入户随访,以及患者及家属有关吸入用药的正规指导和考核,观察两组患者离院后1年内肺功能变化情况及急性加重次数。结果干预前及干预1年后,两组患者肺功能[第1秒用力呼气量(FEV1)、第1秒用力呼气量占预计值百分比(FEV1/pred)]比较,差异均无统计学意义(P>0.05);观察组患者急性加重次数明显少于对照组[(2.81±0.82)次vs.(3.38±0.90)次,t=2.986,P=0.004]。结论对COPD患者进行三位一体的规范化管理,可明显减少患者急性加重次数。

Objective To investigate the effect of standardized hospital-community-family trinity management on the risk of acute onset in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 82 patients diagnosed with acute exacerbation of COPD(AECOPD)in People′s Hospital of Beilun District in Ningbo City from October 2016 to October 2017 were selected.All patients were diagnosed by pulmonary function tests and on the clinical stable stage(grade C and D),and were divided into the observation group(43 cases)and the control group(39 cases).According to the 2016 global initiative for obstructive lung disease(GOLD)guideline,patients in the control group received family education guidance,standardized drug use guidance and telephone follow-up after discharge.On the basis of the above interventions,patients in the observation group received regular follow-up from community doctors trained by the research group,as well as regular guidance and assessment of patients and their families on inhaled medication.Changes of lung function and times of acute exacerbation within one year after discharge were observed in the two groups.Results There was no significant difference in the lung function indexes,including the forced expiratory volume in 1 second(FEV1)and FEV1 percentage of predicted value(FEV1/pred),between the two groups before and one year after intervention(P>0.05).The times of acute exacerbation in the observation group was significantly lower than that in the control group[(2.81±0.82)times vs.(3.38±0.90)times,t=2.986,P=0.004].Conclusion The standardized trinity management of COPD patients could significantly reduce the times of acute exacerbation.