“家庭病床”管理模式对社区稳定期慢性阻塞性肺疾病患者的疗效研究

Home care bed model for management of patients with stable chronic obstructive pneumonia in the community

目的 探索“家庭病床”管理模式对社区稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者的疗效。方法 纳入2019年1月—2019年12月在上海市黄浦区五里桥街道社区卫生服务中心和同济大学附属第十人民医院诊治的200例社区稳定期COPD患者,根据是否应用“家庭病床”管理随机分成干预组和对照组,各100例,随访1年,对比“家庭病床”管理模式干预前后两组患者的一般资料(性别、年龄、吸烟史和BMI)、血指标(PaO_(2)、PaCO_(2)、PCT和CRP)、临床症状(急性加重次数、CAT评分和mMRC评分)、肺功能(FEV1/FVC、FEV1%预计值)的变化和研究期间产生的COPD相关医疗费用。比较干预组和对照组上述资料和指标的差异,并分析干预组内一般资料与上述指标的相关性。结果 经过12个月的管理随访后,对照组和干预组在急性加重次数、COPD相关医疗费用、CAT评分、mMRC评分差值、PaO_(2)、PaCO_(2)、PCT、CRP、FEV1%预计值和FEV1/FVC等方面的差异有统计学意义(均P<0.05)。在干预组100例患者中,年龄与急性加重次数年变化值、ΔCAT评分、ΔmMRC评分、PaCO_(2)变化值、CRP变化值和PCT变化值呈正相关,与ΔFEV1%预计值、ΔFEV1/FVC和PaO2变化值呈负相关;病程与急性加重次数年变化值、ΔCAT评分、ΔmMRC评分、PaCO_(2)变化值、CRP变化值和PCT变化值呈正相关,与ΔFEV1%预计值、ΔFEV1/FVC和PaO2变化值呈负相关;GOLD分级与急性加重次数年变化值、ΔCAT评分、ΔmMRC评分、PaCO_(2)变化值、CRP变化值和PCT变化值呈正相关,与ΔFEV1%预计值、ΔFEV1/FVC和PaO_(2)变化值呈负相关(均P<0.001)。此外,吸烟史与ΔmMRC评分呈正相关(P<0.05)。结论 应用“家庭病床”管理模式可以有效改善COPD患者的呼吸功能、控制酸碱平衡失调、减慢炎性反应进展以及降低医疗支出。接受“家庭病床”管理的患者,随着年龄增加、病程延长和GOLD分级提高,其临床症状加重、炎性反应进展、呼吸功能降低和酸碱平衡失调的风险越大,且吸烟也会增加临床症状加重的风险。

Objective To evaluate the home care bed model for management of patients with stable chronic obstructive pulmonary disease(COPD)in the community.Methods Two hundred patients with stable COPD who visited Wuliqiao Community Health Service Center or Shanghai Tenth People s Hospital from January to December in 2019 were randomly assigned to two groups with 100 cases in each group.Patients in intervention group received home care bed management,while the routine care was provided for patients in control group.Patients were followed up for 1 year;the data of gender,age,smoking history,BMI of patients and the COPD-related medical expenses were documented.The blood index(PaO_(2),PaCO_(2),PCT and CRP),clinical symptoms(the number of acute exacerbations,CAT score and mMRC score),lung function(FEV 1/FVC,FEV 1%predicted value)before and after treatment were compared between two groups.The correlation between the general data and the above indicators in the intervention group was analyzed.Results After 12 months of intervention,compared with the control group,the intervention group had fewer number of acute exacerbations and less COPD-related medical expenses,and the changes in CAT scores and mMRC score,and PaO 2,PaCO_(2),PCT,CRP,FEV 1%predicted value and FEV 1/FVC were smaller(all P<0.05).In intervention group,the age of patients was positively correlated with the number of acute exacerbations,the change values in CAT score,mMRC score,PaCO_(2),CRP and PCT;and negatively correlated with the changes of FEV 1%predicted value,FEV 1/FVC and PaO_(2).The course of disease was positively correlated with the number of acute exacerbations,change values of CAT score,mMRC score,PaCO_(2),CRP and PCT;and negatively correlated with changes of FEV1%predicted value,FEV 1/FVC and PaO_(2).GOLD grade was positively correlated with the number of acute exacerbation,changes in CAT score,mMRC score,PaCO_(2),CRP,and PCT;and negatively correlated with the changes in FEV1%predicted value,FEV 1/FVC and PaO_(2)(all P<0.001).In addition,smoking history was positively correlated with the change in mMRC score(P<0.05).Conclusion The application of home care bed model can effectively improve the respiratory function,control acid-base imbalance and slow down the progress of inflammatory response in stable COPD patients,as well as reduce medical expenditure.However,the factors related the increasing risk of disease aggravation should be concerned for COPD patients receiving home bed care in the community.