Analysis of the Effect of Respiratory Rehabilitation Nursing on the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Objective:To understand the impact of respiratory rehabilitation nursing on the quality of life of patients with chronic obstructive pulmonary disease(COPD),and to provide a theoretical basis for better clinical implementation of this nursing measure.Methods:68 COPD patients admitted from September 2022 to July 2023 were selected to determine the type of COPD(mild,moderate,severe)based on clinical manifestations and laboratory test results,and were divided into a study group(42 cases)and a control group(26 cases),with the control group adopting the conventional treatment plan,and the patients in the study group receiving individualized respiratory rehabilitation nursing care.The patients’respiratory function and quality of life after treatment are observed.Results:The total score of the study group(65.71±12.02)was significantly higher than that of the control group(52.73±11.54),and the difference was statistically significant(P<0.05);in terms of pulmonary function,the results of pulmonary function tests of the two groups of patients were in the normal range after treatment,and the study group was slightly better than that of the control group,and the difference was statistically significant(P<0.05);the score of the study group in terms of exercise endurance was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:Respiratory rehabilitation nursing can effectively improve the quality of life of COPD patients,and is worthy of popularization and application.

The Effect of O2O Education Combined with Peer Education Management Model in Patients with Chronic Obstructive Pulmonary Disease

Objective:To explore the effect of online-to-offline(O2O)education combined with the peer education management model in patients with chronic obstructive pulmonary disease(COPD).Methods:Using convenience sampling,72 patients with COPD who were hospitalized in the respiratory medicine department of a tertiary-level hospital from March to December 2021 were selected as study subjects.Randomized grouping was carried out using the random number table method,the control group was given routine COPD health education in the department,and the intervention group applied O2O trinity health management combined with peer education on the basis of routine care.After 6 months of follow-up after discharge,the two groups were observed and compared for changes in pulmonary function,depression status,self-care ability,and quality of life.Results:At 3 and 6 months after the intervention,the lung function indexes and depression status of the two groups of patients improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the two groups of patients decreased at 3 months after discharge,in which the quality-of-life scores in the intervention group was significantly lower than that of the control group(P<0.05).Conclusion:O2O education combined with the peer education management model can effectively improve the lung function of patients with COPD,depression,self-care ability,and quality of life.

Effects of hospital–community integrated transitional care on quality of life in patients with chronic obstructive pulmonary disease

Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.

Transitional care for patients with chronic obstructive pulmonary disease

Objectives:To observe the effects of transitional care on the quality of life of chronic obstructive pulmonary disease(COPD)patients.Methods:A total of 114 COPD patients were recruited from the First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China and divided equally into an intervention group and control group.Following discharge,patients from the intervention group recieved threemonths intervention in addition to regular nursing care,while control group patients received regular nursing care only.Patients’quality of life was measured using the St.George’s respiratory questionnaire(SGRQ),the 12-item General Health Questionnaire(GHQ-12)and body mass index(BMI).Results:The symptoms section score,the activity section score,the impacts section score,the total score and the rate of mental disorders were significantly changed after the intervention while there was no statistical difference in BMI between groups.Conclusions:Transitional care can improve health-related quality of life in COPD patients who have recently suffered an exacerbation.

Study on the Application Effects of the Teach-Back Method Combined with WeChat Tutorials on Chronic Disease Self-Management in Patients with Chronic Obstructive Pulmonary Disease(COPD)

Objective:To study the application effects of teach-back method combined with WeChat education in patients with chronic obstructive pulmonary disease(COPD).Methods:Convenience sampling was used to select 103 patients with COPD hospitalized in the department of respiratory medicine of a tertiary-level hospital from March to June 2021 as study subjects.Randomized grouping was carried out using the random number table method.The routine care was given in the control group,and the teach-back method combined with WeChat tutorials on the basis of routine care was applied in the intervention group.In the follow-up three months after discharge,the changes in pulmonary function,self-care ability,and quality of life of patients in the two groups were observed and compared.Results:After the intervention,the pulmonary function indexes of both groups improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the patients in the two groups decreased at 3 months after discharge,and the scores of the patients in the intervention group were significantly lower than those of the patients in the control group(P<0.05).Conclusion:The teach-back method combined with WeChat education can effectively improve the pulmonary function,self-care ability,and quality of life of patients with COPD.

Determinants of health-related quality of life worsening in patients with chronic obstructive pulmonary disease at one year

Background Chronic obstructive pulmonary disease （COPD） is a major cause of morbidity and mortality worldwide and has been the leading cause of death in China.Patients with COPD have significant decrements in their health-related quality of life （HRQL）.It is necessary to identify the factors involved in worsening HRQL in order to improve the HRQL of COPD patients.However,evidence from longitudinal studies is limited.The aim of the study was to evaluate the determinants of the deterioration of HRQL in patients with COPD.Methods At baseline,a total of 491 patients with stable COPD received comprehensive assessments,including psychosocial and clinical variables,six minutes walk distance （6MWD）,dyspnea grade measured by the 5-grade Medical Research Council （MRC） dyspnea scale,anxiety and depression measured by the hospital anxiety and depression scale and HRQL measured by St.George＇s Respiratory Questionnaire （SGRQ）.Patients were then monitored monthly for 12 months to document COPD exacerbations.At the end of the study period,the SGRQ values were reassessed.A 1-year change in SGRQ total score ≥4 was defined as a deterioration of the HRQL and as the outcome.A total of 450 patients completed the 12-month follow-up and were analyzed in the present study.Results The age （mean±SD） was （65.0±10.6） years and 68.7％ of subjects were men.The deterioration of the HRQL was 26.4％.In multivariate Logistic regression,independent and graded associations were found between the baseline MRC dyspnoea grade and the deterioration of HRQL （P=0.012）,OR 3.03 （95％ CI 1.11-8.24） for patients with MRC dyspnoea grade ≥4 versus patients with MRC dyspnoea grade =1.Similarly,the number of exacerbations during the follow-up was independently and gradually increased with the deterioration of HRQL （P ＜0.001）,OR 3.03 （95％ CI 1.9-5.6） for the participants with exacerbations ≥3 versus participants with no exacerbation.The 6MWD evaluated by quartiles was negatively associated with the deterioration of HRQL with borderline statistical significance.Conclusion MRC dyspnea grade and the number of exacerbations impair the HRQL of patients with COPD.

The cross-sectional and longitudinal association of the BODE index with quality of life in patients with chronic obstructive pulmonary disease

Background The body mass index, airflow obstruction, dyspnea, and exercise capacity （BODE） index was shown at predicting the risk of death, exacerbation and disease severity among patients with COPD, but few studies verified relationship between BODE index and health related quality of life （HRQoL） among Chinese COPD patients. The objective of this study was to evaluate the relationship between BODE index and HRQoL in cross-sectional and longitudinal association analyses. Methods A multi-center prospective cohort study was initially conducted in 491 stable COPD patients in Beijing, China. Health status （HRQoL） was assessed by St. George＇s Respiratory Questionnaire （SGRQ）; the BODE index was calculated for each patient; dyspnea was assessed using the 5-grade Medical Research Council dyspnea scale. Other measurements included socio-demographic, body mass index （BMI）, lung function test and 6-minute-walk test （6MWT）. Patients were then followed monthly for 12 months. Results Only 450 patients completed the 1-year follow up and were enrolled in our present analyses. Mean age was （65.2 ±10.6）years,＇ men 309 （68.7%）. The BODE index was categorized into 4 subgroups： 0-2, 3-4, 5-6 and 7-10. At baseline BODE index was gradually increased with baseline total SGRQ and SGRQ subscales （P trend 〈0.001）. For individual components of BODE index, with the decrease of airflow limitation, and 6MWD, and with the increase of Medical Research Council （MRC） dyspnea grade, total SGRQ and SGRQ subscales were increased correspondingly, P trend 〈0.05, respectively. Similar association patterns were found between baseline BODE index and its individual components and mean SGRQ scores at the end of 1-year follow up. By multiple linear regression analyses, baseline BODE index was not only significantly associated with SGRQ score at baseline but also with SGRQ score at the end of 1-year follow up after adjustment for age, male, current smoking, 13s being 0.434 and 0.378, respectively. Conclusions BODE index is associated with SGRQ score cross-sectionally and longitudinally among stable COPD patients. BODE index might have potential to be used as a sensitive tool to assess the status of quality of life and to monitor disease progression among stable COPD patients.

Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure

Background Chronic obstructive pulmonary disease （COPD） and congestive heart failure （CHF） are two chronic diseases that affect negatively the functional condition and quality of life of patients. We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients. Methods The study included 42 COPD and 39 CHF patients. In both patient groups, dyspnea was assessed using Borg scale; functional capacity by shuttle-walk and cardiopulmonary exercise test and quality of life by short form-36 （SF36）. Results No statistically significant difference was found in neither of the two disease groups regarding the dyspnea score, shuttle-walk test and the majority of subgroup scores of SF36 （P〉0.05）. A statistically significant difference was observed in peak VO2 in favor of COPD group （P〈0.05）. No significant relationship was established between dyspnea score and forced expiratory volume in one second （FEV1） in COPD patients, and left ventricular ejection fraction （LVEF） in CHF patients （P〉0.05）. A significant negative correlation was observed between dyspnea score and functional capacity tests in both disease groups （P〈0.05）. On the other hand, no relationship was found between LVEF and FEV1 and quality of life and functional capacity （P〉0.05）. Conclusions It was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups, however, objective indicators of disease severity do not show a similar relationship. Therefore, in addition to the objective data related to the disease, we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease

OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patients with stable COPD(according to defined criteria)in this cross-sectional study from four three-level class A Chinese medicine hospitals in China.We built an Epidata 3.0 database and performed statistical analysis with SPSS,version 17.0.We analyzed correlations between the frequency of lower gastrointestinal tract symptoms(constipation and abdominal distention)and scores for major pulmonary symptoms(cough,sputum and wheezing)based on the St.George's Respiratory Questionnaire(SGRQ),6-minute walking distance(6MWD)and frequency of acute exacerbations of COPD(AECOPD).RESULTS:In addition to their pulmonary symptoms,39.79%and 40.31%of study patients withstable COPD reported constipation and abdominal distention,respectively.Scores for major pulmonary symptoms(cough,sputum and wheezing),AECOPD and SGRQ values in patients with constipation and abdominal distention were significantly greater,and the 6MWD markedly shorter,than in those without them.According to Pearson's correlation analysis,there were strong correlations between these lower gastrointestinal tract symptoms and scores for pulmonary symptoms,SGRQ,6MWD and AECOPD.CONCLUSION:Lower gastrointestinal tract symptoms such as constipation and abdominal distention can adversely affect pulmonary symptoms,frequency of acute exacerbations and quality of life in patients with stable COPD.

Chronic obstructive pulmonary disease assessment test score correlated with dyspnea score in a large sample of Chinese patients

Background The chronic obstructive pulmonary disease assessment test （CAT） is an easy to use health-related quality of life questionnaire, the modified Medical Research Council （mMRC） dyspnea scale is a classic dyspnea scale which is widely used, while the correlation between them is still not clear. This study investigated the use of the Chinese translation of CAT in chronic obstructive pulmonary disease patients and its correlation with the mMRC dyspnea scale. Methods The multicenter cross-sectional study was conducted in 329 hospitals throughout China from March 1 to April 30, 2010. Chronic obstructive pulmonary disease patients completed both the assessment test and the dyspnea scale during a single study visit. Results Six thousand, four hundred and thirty-seven patients were evaluated; 74.9% were male and the mean age was （64.9±10.0） years. Median test scores in dyspnea grades 0 to 4 were 14, 16, 22, 26 and 32, respectively; these differences were statistically significant. The CAT score was moderately correlated with mMRC dyspnea grade （r=0.579, P 〈0.001）. There was no significant difference in mean CAT score between males and females, and patients of high and low socioeconomic status. Primary analysis suggested that CAT scores were higher in older patients （〉65 years） than in younger patients （〈65 years） and increased with duration of formal education, but these findings were repudiated by further analysis of subgroups according to mMRC dyspnea grade. Conclusions There was no obvious confounding factor influencing use of the CAT in Chinese patients. CAT scores were moderately correlated with the mMRC dyspnea scale.

Effect of Yiqibushenhuoxue decoction on chronic obstructive pulmonary disease measured by St. George's respiratory disease questionnaire scores and forced expiratory volume

OBJECTIVE: To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease(COPD) by observing its influences on patients' quality of life and airway inflammation.METHODS: Seventy patients with stable COPD were randomly divided into a treatment group(n=35) treated with Yiqibushenhuoxue decoction plus Seretide and a control group(n=35) treated with Seretide only.The dosage of Yiqibushenhuoxue decoction was 100 mL each time, twice a day, and the dosage of Seretide was salmeterol 50 μg/fluticasone 250 μg twice a day. Both groups were treated for 12 weeks. Before and after the treatment, St George's respiratory disease questionnaire(SGRQ)scores,forced expiratory volume,and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were measured.RESULTS:The SGRQ scores in both groups were significantly lower than those before treatment(P<0.05). After treatment, the total SGRQ scores and each subscore in the treatment group were significantly lower than those in the control group(P<0.05). The percentage of the predicted FEV1% and FEV1/FVC were higher in both groups, but no statistical differences were detected from before to after the treatment or between the two groups(P>0.05).CONCLUSION: Yiqibushenhuoxue decoction could significantly decrease the SGRQ scores in patients with stable COPD, which suggests that it is able to improve patient symptoms.

Advanced Chronic Obstructive Pulmonary Disease： Innovative and Integrated Management Approaches

Chronic obstructive pulmonary disease （COPD） is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. By the year 2020, COPD will be the third leading cause of mortality and the fifth leading cause of disability worldwide, In a population based study conducted at multiple international sites, approximately 10% of participants 40 years of age or older were found to have airflow obstruction of at least moderate severity according to spirometric criteria. In China, the overall prevalence of COPD in individuals 40 years of age or older was 8.2%.m COPD is a slowly progressive respiratory disease, which, although preventable and treatable, is not curable. The final years for patients with advanced COPD are characterized by progressive functional decline, frequent exacerbations, poor quality of life, increasing dependency on informal caregivers and on the health care system. According to the literature, 5-year survival from diagnosis is estimated to be 78% in men and 72% in women with mild disease, but only 30% in men and 24% in women with advanced COPD.

Effects of TCM Nursing Based on Syndrome Differentiation on Pulmonary Function and Quality of Life in Patients with Acute Exacerbation of COPD

[Objectives] To investigate the effects of TCM nursing based on syndrome differentiation on pulmonary function and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). [Methods] A total of 92 patients with AECOPD who came to Nanchong Chinese Medicine Hospital from March 2022 to February 2023 were selected for the study, and the intervention group (TCM nursing based on syndrome differentiation, 46 cases) and the conventional group (basic nursing, 46 cases) were selected for the study, and the pulmonary function and quality of life of the two groups were compared. [Results] Before nursing, there was no significant difference in levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and percentage of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) between the intervention group and conventional group ( P >0.05). After 3 months of nursing, the levels of FVC, FEV1 and FEV1/FVC in the intervention group were higher than those in the conventional group ( P <0.05). Before nursing, there was no significant difference in the scores of health, emotion and social functions between the two groups ( P >0.05). At three months of nursing, the scores of health, emotion, and social functions in the intervention group were higher than those in the conventional group ( P <0.05). [Conclusions] The implementation of TCM nursing based on syndrome differentiation in patients with AECOPD can effectively improve the pulmonary function and quality of life of patients, and has significant clinical implementation value.

Health-Related Quality of Life, Depression, and Smoking Status in Patients with COPD: Results from the Behavioral Risk Factor Surveillance System Data

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality. People living with COPD often have a common triad of problems including decreased health-related quality of life (HRQL), smoking, and depression. Identifying barriers to preventing and treating COPD is of the utmost importance. The purpose of this study is to examine the relationship between HRQL, depression, and smoking status for patients with COPD. Methods: The 2016 BRFSS data was used to perform a cross sectional analysis of adult patients with a diagnosis of COPD. A comprehensive descriptive analysis of all study variables for those participants having COPD was performed. Then relationships between general HRQL, depression, and smoking status were examined. Data were analyzed using SPSS. Results: The original 2016 BRFSS dataset contained responses from 486,303 participants. After selecting participants who self-identified as having a diagnosis of COPD, 40,682 individual participants remained in the dataset for further analysis. The participants with COPD were mostly female, over the age of 65, with low-incomes, attended a year of college or less, with some type of healthcare coverage. Patients with a dual diagnosis of COPD and depression have poorer HRQL and an increased number of cigarettes smoked compared to those patients with COPD. Likewise, there is a significant relationship between HRQL and smoking status for patients with a dual diagnosis of COPD and depression. Conclusion: Depression as a comorbidity does have a statistically significant relationship with patients HRQL and smoking status. Future research should be aimed at increasing screening and treatment for depression in patients with COPD who continue to smoke. Further research on the cyclical relationship between COPD, depression, and smoking cessation would be beneficial.

揿针治疗肺肾气虚型慢性阻塞性肺疾病稳定期疗效研究

目的:研究揿针治疗肺肾气虚型慢性阻塞性肺疾病(COPD)稳定期的临床疗效。方法:前瞻性选择COPD患者200例,随机分为两组,对照组给予常规西医治疗,观察组在其基础上加用予揿针治疗,疗程为8周。记录两组的临床疗效,并比较两组治疗前后中医症状积分、6 min步行距离和衰弱筛查量表评分、改良英国MRC呼吸困难指数问卷(mMRC)、肺功能及圣乔治呼吸问卷(SGRQ)评分。两组治疗后均随访6个月,记录两组急性加重的次数。结果:观察组与对照组临床总有效率分别为92.00%和71.00%,前者显著高于后者(P<0.05)。与治疗前比较,两组治疗后中医症状积分和衰弱筛查量表评分均明显降低,6 min步行距离增加(P<0.05),且观察组治疗后中医症状积分和衰弱筛查量表评分低于对照组,6 min步行距离大于对照组(P<0.05)。与治疗前比较,两组治疗后mMRC分级及平均分、SGRQ问卷总分及各维度评分均明显降低,第1秒用力呼气容积(FEV 1)、用力肺活量(FVC)、最大呼气流量(PEF)、第1秒用力呼气量/用力肺活量(FEV 1/FVC)均明显增大(P<0.05),且观察组治疗后的mMRC分级及平均分、SGRQ问卷总分及各维度评分均低于对照组(P<0.05),肺功能指标高于对照组(P<0.05)。两组治疗后均随访6个月,观察组急性加重次数显著低于对照组(P<0.05)。结论:揿针治疗肺肾气虚型COPD稳定期患者的疗效确定,不仅能改善其临床症状,改善疲劳衰弱状况与增强运动耐量,还能减轻呼吸困难程度并提高肺功能,显著改善生存质量,减少COPD急性发作次数。

综合评估指导的中医护理干预在老年COPD患者中的应用效果

目的分析老年慢性阻塞性肺疾病(COPD)患者实施综合评估为指导的中医护理干预,对其衰弱状态、生活质量、肺功能及营养状态的影响,旨在改善老年COPD患者的衰弱状态,提高其生活质量和功能独立性,对于优化老年COPD患者的管理和护理提供依据。方法研究对象为启东市中医院呼吸内科在2021年4月—2023年3月收治且符合研究要求的COPD患者180例,基于组间基线资料具有可比性条件下将纳入患者分为对照组和观察组各90例。对照组行常规护理干预,观察组患者给予老年综合评估指导下的中医护理干预。比较观察两组患者衰弱状态、肺功能水平[第一秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)、第一秒用力呼气容积占预计值百分比(FEV_(1)%)]、营养状况[血清总蛋白(TP)、白蛋白(ALB)水平和NRS-2002评分]以及生活质量[慢性阻塞性肺疾病评分(CAT)]变化情况。结果干预前两组患者衰弱状态分级、TP、ALB水平、NRS-2002评分、FEV_(1)/FVC、FEV_(1)%水平、CAT评分比较差异无统计学意义(P>0.05)。干预后,观察组患者衰弱状态轻于对照组,观察组TP、ALB水平高于对照组,NRS-2002评分低于对照组,观察组FEV_(1)/FVC、FEV_(1)%水平高于对照组,观察组CAT评分低于对照组,两组以上指标比较差异均有统计学意义(P<0.05)。结论老年综合评估指导下的中医护理干预策略可进一步提高患者营养水平和肺功能,最终改善患者衰弱状态,减轻COPD对生活质量的影响。

1990-2019年中国慢性阻塞性肺疾病的疾病负担分析及未来10年发病预测

目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据库(Global burden of disease study,GBD),研究分析1990-2019年中国慢性阻塞性肺疾病的发病、患病、死亡、伤残调整寿命年(DALY)、早死寿命损失年(YLL)、伤残寿命损失年(YLD)等情况。采用贝叶斯-时期-队列分析(BAPC)方法,预测2020-2030年中国慢性阻塞性肺疾病发病率。结果相对于1990年,2019年中国慢性阻塞性肺疾病粗患病率增长35.44%,标化患病率减少27.16%,粗发病率增长38.31%,标化发病率减少28.52%,粗死亡率减少30.59%,标化死亡率减少70.08%。1990-2019年中国人群因慢性阻塞性肺疾病导致的YLL率由3281.48/10万降至862.37/10万,YLD率由330.33/10万降至240.40/10万,DALY率由3611.81/10万降至1102.77/10万。2019年男性慢性阻塞性肺疾病DALY率相比于1990年降低66.56%,女性DALY率相比于1990年降低71.87%。2020-2030年中国慢性阻塞性肺疾病标化发病率预计呈下降趋势,2030年男性标化发病率预计比2020年降低31.97%,女性标化发病率预计比2020年降低27.69%。结论1990-2019年,慢性阻塞性肺疾病对中国人口造成的疾病负担总体呈下降趋势。但从患病情况和死亡情况来看,发病及死亡人数较多,中国慢性阻塞性肺疾病的疾病负担仍处于较高水平。同时预测结果显示,未来10年中国慢性阻塞性肺疾病标化发病率在下降,但是仍处于较高水平,因此进行早筛查、早预防和早治疗,及广泛开展慢阻肺相关知识普及,对于做好COPD疾病管理具有重要意义。

八段锦功法对慢性阻塞性肺疾病患者去脂肪指数及焦虑抑郁状态的影响

目的探讨八段锦功法指导慢性阻塞性肺疾病(COPD)患者去脂肪指数(FFMI)及焦虑状态的影响。方法将2021年7月至2023年7月新疆医科大学第一附属医院的154例COPD住院患者按照住院顺序分为基础治疗组和八段锦治疗组。基础治疗组给予常规治疗,不增加运动训练;八段锦治疗组在常规治疗基础上配合八段锦训练及专业运动指导。12周后2组患者采用体成分测定评估治疗前后中医症候评分、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、慢性阻塞性肺疾病评估测试问卷(CAT),采用ELISA方法检测外周血肿瘤坏死因子样弱凋亡诱导因子(TWEAK)水平,比较治疗前后患者焦虑、抑郁状态改善情况。结果基础治疗组患者治疗后CAT评分减少,差异有统计学意义(P<0.05);中医症候评分、HAMA及HAMD评分无变化(P>0.05)。八段锦治疗组患者治疗后,中医症候评分、CAT评分、HAMA及HAMD评分减少,差异有统计学意义(P<0.05)。基础治疗组的肺功能变化不大(P>0.05)。八段锦治疗组患者第1秒用力呼气容积占用力肺活量的比例、第1秒用力呼气容积等指标治疗前后变化不大(P>0.05);呼气峰值流速占预计值百分比在治疗后较治疗前低,差异有统计学意义(P<0.05)。基础治疗组患者治疗前后FFMI无变化(P>0.05)。八段锦治疗组患者治疗前后FFMI升高,差异有统计学意义(P<0.05)。结论八段锦训练能够减轻COPD患者气道阻塞情况,提高肌肉质量,缓解患者焦虑抑郁状态,提高患者生活质量。

PERMA模式在老年慢阻肺患者肺功能与生活质量改善中的应用研究

目的本研究通过分析PERMA模式下激励干预对老年COPD患者心理健康和生活质量的影响,以期为临床积极心理学的干预应用提供更多试验依据。方法回顾性分析2020年12月—2022年12月在首都医科大学附属北京朝阳医院接受治疗的90例老年COPD患者的临床资料,依据不同的干预方式将患者分为观察组(45例)和对照组(45例)。对照组患者行常规干预,观察组在与对照组相同干预基础上加用PERMA模式下激励干预,2组患者均持续干预2周。干预前后对2组应用简明心境问卷(POMS-SF)评估心理健康,采用健康状况问卷量表(SF-36)评估生活质量,记录2组肺功能指标值,并对上述检测值进行比较和统计学分析。结果干预前,观察组和对照组患者POMS-SF各分量表评分差异均无统计学意义(P>0.05)。干预后,观察组和对照组患者精力-活力评分均较同组干预前升高,迷惑-混乱、紧张—焦虑、疲乏—迟钝、抑郁—沮丧和愤怒—敌意评分均较同组干预前降低,且观察组精力—活力评分高于对照组,迷惑—混乱、紧张—焦虑、疲乏—迟钝、抑郁—沮丧和愤怒—敌意评分均低于对照组,差异均有统计学意义(P<0.05)。干预前,观察组和对照组患者SF-36量表评分差异均无统计学意义(P>0.05)。干预后,观察组和对照组患者总体健康、生理功能、活力、生理职能、情感职能、社会功能、精神健康和躯体疼痛评分均较同组干预前升高(P<0.05),且观察组SF-36量表各项评分均高于对照组(P<0.05)。干预前,观察组和对照组患者FVC、FEV1、FEV1/FVC值差异均无统计学意义(P>0.05);干预后,观察组和对照组患者FVC、FEV1/FVC值均较同组干预前升高,且观察组FVC、FEV1/FVC值高于对照组(均P<0.05)。结论PERMA模式下激励干预可能改善老年慢阻肺患者心理健康与生活质量,提高患者的肺功能水平,改善患者的预后。

布地格福联合白葡奈氏菌片维持治疗中重度慢性阻塞性肺疾病稳定期患者的临床观察

目的 考察布地格福联合白葡奈氏菌片维持治疗中重度慢性阻塞性肺疾病(COPD)稳定期患者的临床效果。方法 将2021年10月1日至2023年1月31日于我院呼吸与危重症医学科感染病区就诊的122例中重度COPD稳定期患者,按照随机数字表法分为对照组(n=61)和观察组(n=61)。对照组患者单用布地格福吸入气雾剂(每次2揿,每日2次),观察组患者在对照组用药的基础上加用白葡奈氏菌片(每次1.2 mg,每日3次),两组疗程均为3个月。比较两组患者治疗前后的生活质量、运动耐量、肺功能、炎症指标、免疫功能,以及COPD急性发作次数和不良反应发生情况。结果 对照组和观察组分别脱落12、9例患者。治疗后,两组患者的6分钟步行距离均较治疗前显著延长(P<0.05),COPD评估测试问卷评分、St George’s呼吸问卷评分、残气量与肺总量的比值、呼出气一氧化氮浓度、血清C反应蛋白及白细胞介素6水平均较治疗前显著降低(P<0.05),第1秒用力呼气容积(FEV_1)、FEV_1与用力肺活量的比值、肺一氧化碳弥散量实测值占预计值的百分比以及FEV_1实测值占预计值的百分比均较治疗前显著升高(P<0.05),且观察组上述指标的改善程度均显著优于对照组(P<0.05)。与治疗前比较,治疗后对照组患者的免疫功能指标及观察组患者的血清免疫球蛋白A(IgA)、IgM水平差异均无统计学意义(P>0.05);观察组患者的CD3~+、CD4~+、B淋巴细胞、自然杀伤细胞的百分比和CD4~+/CD8~+以及IgG水平均显著升高(P<0.05),CD8~+细胞百分比显著降低(P<0.05),且观察组的改善程度均显著优于对照组(P<0.05)。两组患者在随访期间的COPD急性发作次数和治疗期间的不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 布地格福联合白葡奈氏菌片能有效改善中重度COPD稳定期患者的免疫功能,降低其炎症水平,提升其运动耐量和生活质量,且用药安全性较好。