个案管理在慢性阻塞性肺疾病患者延续护理中的效果评价

Evaluation of the effect of case management in continuous care of patients with chronic obstructive pulmonary disease

目的:评价个案管理在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者延续护理中的效果。方法:选取2019年7月—2020年12月上海市长宁区虹桥街道社区卫生服务中心诊治的COPD患者100例,按照随机数字表方法分成对照组和观察组各50例。对照组仅进行门诊医生随访和社区护士电话随访,观察组采取从健康宣教、专病管理、康复训练和营养评估四个方面的个案管理。比较两组在进行6个月、1年、1年半的管理后,肺功能指标、生命质量评分、知信行评分的变化情况。结果:观察组干预后1年、1年半时的第一秒用力呼气容积(forced expiratory volume in one second,FEV1)、第一秒用力呼气容积占用力肺活量比值(FEV1/Forced vital capcacity,FEV1/FVC)和知信行水平评分均高于对照组(均P<0.05)。观察组干预后6个月、1年、1年半时的生命质量评分均低于对照组(P<0.05)。结论:个案管理在COPD患者延续护理中具有重要作用,能够显著改善患者肺功能指标,提升其生活质量水平,值得研究和推广。

Objective:To evaluate the effect of the case management in continuous care of patients with chronic obstructive pulmonary disease(COPD).Methods:A total of 100 COPD patients diagnosed and treated in Hongqiao Community Health Service Center,Changning District,Shanghai from July 2019 to December 2020 were selected and divided into a control group and an observation group with 50 patients in each group according to random number table method.The control group was only followed up by out-patient doctors and community nurses by telephone,while the observation group adopted case management from four aspects:health education,special disease management,rehabilitation training and nutrition assessment.After 6 months,1 year and 1 and a half years of management,lung function indexes,quality of life scores and knowledge,attitude and practice(KAP)scores changes of the two groups were compared.Results:The forced expiratory volume in one second(FEV1),the ratio of FEV1/forced vital capacity(FEV1/FVC)and the scores of KAP in the observation group at 6 months,1 year and 1.5 years after intervention were higher than those in the control group(all P<0.05).The life quality score of the observation group was lower than that of the control group at 6 months,1 year and 1 and a half after intervention(P<0.05).Conclusion:Case management plays an important role in the continuous care of COPD patients,can significantly improve the lung function indicators of patients,and improve their quality of life,which is worthy of research and promotion.