个案管理模式在慢性阻塞性肺疾病稳定期患者护理中的应用

The application of case management model on the stable patients with chronic obstructive pulmonary disease

目的 探讨个案管理模式对慢性阻塞性肺疾病(COPD)稳定期患者健康知识水平、急性加重次数以及生命质量的影响.方法 将50例COPD稳定期患者按随机数字表法分为试验组和对照组各25例.对照组实施常规护理,试验组给予为期3个月的个案管理模式干预,并比较干预前和干预1、2、3个月2组患者的COPD健康知识问卷(CKQ)得分、圣乔治呼吸问卷(SGRQ)得分、急性加重次数等的差异.结果 对照组剔除1例.试验组患者干预1、2、3个月CKQ总分分别为(28.04±1.43)、(28.20±1.00)、(28.40±1.04)分,均较对照组的(18.08±2.30)、(18.50±1.87)、(18.33±1.66)分显著提高,差异有统计学意义(t=18.109、22.556、25.320,均P＜ 0.01).试验组患者干预2、3个月SGRQ总分和症状分分别为(50.56±8.68)、(49.40±8.05)、(41.52±10.86)、(37.16±8.90)分,均较对照组的(57.42±10.22)、(59.46±9.06)、(54.50±8.67)、(56.71±10.03)分改善,差异有统计学意义(t=-7.222-2.536,P＜0.05或0.01).试验组患者干预1、2、3个月影响分分别为(46.28±8.74)、(44.40± 8.11)、(42.04±8.22)分,均较对照组的(51.50±7.77)、(51.79±8.06)、(54.08±6.96)分改善,差异有统计学意义(t=-2.206、-3.197、-5.523,P＜0.05或0.01).干预前后2组患者的活动分差异无统计学意义(P＞0.05).试验组患者在干预3个月内的急性加重次数1次3例,0次22例,对照组分别为9、15例,差异有统计学意义(x2=4.306,P＜0.05).结论 个案管理模式可以促进COPD稳定期患者了解更多的疾病相关健康知识,提高其健康知识水平,减轻患者的症状,减少急性加重次数,降低疾病对日常生活的影响,阻止活动耐力的进一步下降,改善生命质量.

Objective To evaluate the effect of case management model on the stable patients with chronic obstructive pulmonary disease (COPD),containing health knowledge level,the number of acute exacerbation and the quality of life.Methods Fifty patients were divided into the experimental group and the control group with 25 cases each by random digits table method.The experimental group received the case management model for 3 months.The control group received routine care for 3 months.The COPD health Knowledge Questionnaire(CKQ) scores and St George's Respiratory Questionnaire(SGRQ) scores were measured for 4 times (the beginning of the intervention and 1 months,2 months,3 months later),and the numbers of acute exacerbation were measured at 3 months later.Results The CKQ scores at 1,2,3 months after intervention were (28.04±1.43),(28.20±1.00),(28.40±1.04) points in the experimental group,and (18.08±2.30),(18.50±1.87),(18.33±1.66) points in the control group,and there were significant differences (t=18.109,22.556,5.320,all P ＜ 0.01).The scores of SGRQ and symptom at 2 months and 3 months after intervention were (50.56±8.68),(49.40±8.05),(41.52±10.86),(37.16±8.90) points in the experimental group,and (57.42±10.22),(59.46±9.06),(54.50±8.67),(56.71 ±10.03) points in the control group,and there were significant differences (t=-7.222-2.536,P ＜ 0.05 or 0.01).The influence scores at 1,2,3 months after intervention were (46.28±8.74),(44.40±8.11),(42.04±8.22) points in the experimental group,and (51.50±7.77),(51.79±8.06),(54.08±6.96) points in the control group,and there were significant differences(t=-2.206,-3.197,-5.523,P ＜ 0.05 or 0.01).There was no statistically significant difference about activity scores between two groups before and after intervention (P ＞ 0.05).The numbers of acute exacerbation during 3 months with 3,22 cases in 1 and 0 time in the experimental group and 9,15 cases in the control group,and there was statistically difference between two groups(x2=4.306,P＜ 0.05).Conclusions The case management model can promote the stable COPD patients to know more disease-related health knowledge,and improve the health knowledge level.The case management model can reduce the symptoms of the stable COPD patients,reduce the frequency of acute exacerbation,reduce the influence of disease on daily life,prevent further decline in activity endurance,and improve the quality of life.