罗伊适应模式在慢性阻塞性肺疾病患者社区管理中的应用效果

Effect of community management based on Roy′s adaptation model in patients with chronic obstructive pulmonary disease

目的探讨罗伊适应模式在慢性阻塞性肺疾病(简称慢阻肺)患者社区管理中的应用效果。方法本研究为整群随机对照研究,以社区为整群单位,抽取2019年6月前已经完成社区登记的徐州市8个社区中的805例慢阻肺患者,实际完成随访并参与干预评估调查者共735例。采用随机数表法将其随机分为对照组(362例)和干预组(373例)。对照组进行常规随访,干预组采取罗伊适应模式干预6个月。患者肺功能、呼吸困难、适应能力、心理状况和生活质量改善分别用第1秒用力呼气量占用力肺活量比值(FEV1/FVC)、改良版英国医学研究委员会呼吸问卷(mMRC)、医院焦虑抑郁量表(HADS)、简易罗伊应对适应量表(CAPS-15)和圣乔治呼吸问卷(SGRQ)评估。干预前组间评估指标的比较,采用t检验或χ^(2)检验;干预后组间比较采用重复测量的方差分析。结果干预6个月后干预组与对照组FEV1/FVC值差异无统计学意义[(0.61±0.11)比(0.62±0.12)](P=0.172)。mMRC评分[(2.04±0.33)比(2.77±0.31)分]、HAD-A[(5.28±4.28)比(6.99±4.41)分]和HAD-D[(5.82±5.12)比(7.27±4.93)分]、SGRQ[(40.17±9.30)比(53.69±9.77)分]均显著低于对照组(均P<0.001);CAPS-15得分干预组高于对照组[(35.87±3.62)比(26.10±3.47)分,P<0.001]。结论罗伊适应模式可用于慢阻肺患者的社区管理,能改善患者呼吸困难和心理状况,提高患者的适应力和生活质量。

Objective To determine the effect of community management based on the Roy′s adaptation model(RAM)in patients with chronic obstructive pulmonary disease(COPD).Methods This study was a cluster randomized controlled study,with the community as the cluster unit,and selected 805 COPD patients from 8 communities in Xuzhou City who had completed community registration before June 2019.A total of 735 patients actually completed follow-up and participated in intervention evaluation.They were randomly divided into control group(362 cases)and intervention group(373 cases)by random number table method.The control group received routine follow-up,while the intervention group received RAM intervention for 6 months.The forced expiratory volume in 1 second(FEV1)/forced volume vital capacity(FVC)ratio(FEV1/FVC)and the modified British medical research council(mMRC)were used to assess the pulmonary function.The hospital anxiety and depression scales(HADS)were used to evaluate the mental health.The Chinese version of the Short Form Coping and Adaption Processing Scale(CAP-15)was used to assess the adaptive capacity.And the St.George′s Respiratory Questionnaire(SGRQ)was used to evaluate the quality of life in COPD patients.The t test orχ2 test was used for pre-intervention comparisons between groups,and the repetitive measure analysis of variance(ANOVA)was used for post-intervention comparisons between groups.Results After 6 months intervention,there were no significant differences in FEV1/FVC radio between the two groups[(0.61±0.11)vs(0.62±0.12)](P=0.172).The scores of mMRC[(2.04±0.33)vs(2.77±0.31)points],HAD-A[(5.28±4.28)vs(6.99±4.41)points],HAD-D[(5.82±5.12)vs(7.27±4.93)points]and SGRQ[(40.17±9.30)vs(53.69±9.77)points]were all lower in the intervention group than those in the control group(all P<0.001).The CAPS-15 score was higher in the intervention group than that in the control group[(35.87±3.62)vs(26.1±3.47)](P<0.001).Conclusion RAM could be used in community management of COPD patients,which could improve their dyspnea symptoms and psychological and physiological functions,also improve their adaptability and quality of life.