2014-2015年中国40岁及以上慢性阻塞性肺疾病患者呼吸康复治疗情况

Analysis on respiratory rehabilitation in patients with chronic obstructive pulmonary disease aged 40 years or older in China,2014-2015

目的了解中国≥40岁慢性阻塞性肺疾病(慢阻肺)患者的呼吸康复治疗和吸氧治疗情况,为肺康复治疗的发展提供基础数据。方法来源于2014-2015年中国居民慢性阻塞性肺疾病监测,采用多阶段分层整群随机抽样方法在31个省(直辖市、自治区)125个监测点抽取≥40岁常住居民,利用电子问卷通过面对面询问的方式收集有关呼吸康复治疗和吸氧治疗的相关变量,通过肺功能检查将支气管舒张试验后FEV1/FVC<70%者诊断为慢阻肺患者,共诊断患者9134例,基于复杂抽样设计估计我国≥40岁慢阻肺患者的呼吸康复治疗和吸氧治疗率,并分析其影响因素。结果9118名≥40岁慢阻肺患者纳入分析。慢阻肺患者呼吸康复治疗率为0.8%(95%CI:0.6%~1.0%),吸氧治疗率为2.5%(95%CI:2.0%~2.9%)。症状重/急性加重风险高的慢阻肺患者(慢阻肺综合评估在B、C、D组患者)的呼吸康复治疗率为1.4%(95%CI:0.9%~1.9%),吸氧治疗率为5.4%(95%CI:4.4%~6.4%)。多因素logistic回归分析结果显示,城乡、地区、慢阻肺患病知晓、急性加重史和气流受限严重程度影响慢阻肺患者的呼吸康复治疗率,性别、地区、慢阻肺患病知晓、急性加重史、mMRC评级和气流受限严重程度影响患者的吸氧治疗率。结论中国≥40岁慢阻肺患者的呼吸康复治疗和吸氧治疗水平较低,应探索方便、有效的慢阻肺患者管理和肺康复治疗模式,让更多的患者获得科学的肺康复治疗。

Objective To understand the situation of respiratory rehabilitation and oxygen inhalation therapy in chronic obstructive pulmonary disease(COPD)patients aged 40 years or older in China,and provide basic information for the development of pulmonary rehabilitation.Methods The data were from 2014-2015 COPD surveillance in China.Chinese residents aged 40 years or older were recruited through a complex multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces(autonomous regions,municipalities).Standardized face to face electronic questionnaires were used to collect information about respiratory rehabilitation and oxygen inhalation therapy of the patients.Spirometry was performed on all participants,and patients with post-bronchodilator FEV1/FVC<70%were diagnosed with COPD.The number of defined COPD patients was 9134.Based on the complex sampling design,the respiratory rehabilitation treatment rate and oxygen inhalation therapy rate of COPD patients aged 40 years old or older in China were estimated,and the influencing factors were analyzed.Results A total of 9118 COPD patients aged 40 years or older were included in the analysis.The rate of respiratory rehabilitation was 0.8%(95CI:0.6%-1.0%),and the rate of oxygen inhalation therapy was 2.5%(95%CI:2.0%-2.9%).Among patients with severe symptoms or high risk of acute exacerbation(combined COPD assessment groups B,C,D),the rate of respiratory rehabilitation was 1.4%(95%CI:0.9%-1.9%),and the rate of oxygen inhalation therapy was 5.4%(95%CI:4.4%-6.4%).Multivariate logistic regression analysis showed that urban or rural residences,geographic area,awareness of COPD,history of acute exacerbation and severity of airflow restriction had influences on the respiratory rehabilitation rate in the COPD patients.Gender,geographic area,awareness of COPD,history of acute exacerbation,mMRC scores and severity of airflow restriction had influences on the patients’oxygen inhalation therapy rate.Conclusions The rate of respiratory rehabilitation and oxygen inhalation therapy in COPD patients aged 40 years or older was relatively low in China.It is necessary to explore an effective model of pulmonary rehabilitation and COPD management,so that more COPD patients may have access to scientific pulmonary rehabilitation treatment.