慢性阻塞性肺疾病急性加重病人多症状现状及其特征分类研究

Study on the status and characteristic classification of multiple symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease

目的:描述慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)病人多症状现状,对其多症状进行特征分类,为提供针对性的干预提供参考。方法:采用便利抽样法选取2018年5月—2020年1月某三级甲等医院住院的202例AECOPD病人为研究对象,采用一般资料调查表、改良的呼吸困难指数分级(Modified Medical Research Council, mMRC)、修订版记忆症状评估量表、COPD自我效能量表对其进行问卷调查,采用主成分因子分析和聚类分析法对病人多症状特征及群体异质性进行特征分类。结果:分为多症状低度组(n=103)、多症状中度组(n=60)、多症状高度组(n=39)3个亚组,其中高度组病人mMRC得分明显高于其他两组(均P<0.01),呼吸困难管理、体力活动、情感波动维度得分及自我效能总分低于低度组(均P<0.05)。结论:AECOPD病人的多症状存在群体异质性,导致病人不同程度的困扰,多症状3个亚组的识别可为个体化症状管理提供参考。

Objective:To describe the status of multi-symptoms of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and identify their typologies,so as to provide references for targeted intervention.Methods:A total of 202 patients with AECOPD who were hospitalized in a third A hospital from May 2018 to January 2020 were selected as research objects by convenience sampling method.General Information Questionnaire,Modified Medical Research Council(mMRC),Revised Memorial Symptom Assessment Scale and COPD Self-Efficacy Scale were used to investigate the patients.Principal component factor analysis and cluster analysis were used to identify the symptom subgroups based on symptom characteristics and population heterogeneity.Results:A total of 202 patients with AECOPD could be divided into three subgroups:multi-symptom low-grade group(n=103),multi-symptom moderate group(n=60)and multi-symptom high-grade group(n=39).The mMRC score of patients in the high-grade group was significantly higher than that in the other two groups(all P<0.01).The scores of dyspnea management,physical activity,emotional fluctuation dimension and total self-efficacy were lower than those of low degree group(all P<0.05).Conclusions:There is population heterogeneity in AECOPD patients with multiple symptoms,which leads to different degrees of distress.The identification of three subgroups of multiple symptoms can provide reference for individualized symptom management.