长期系统教育管理可以提高慢性阻塞性肺疾病的控制水平

目的评价长期系统教育管理模式对慢性阻塞性肺疾病（简称慢阻肺）的干预效果。方法根据管理模式的不同,将慢阻肺患者分为系统教育组、单纯随访组和对照组。于2013年3月至2013年8月对246例稳定期慢阻肺患者进行面对面调查。主要内容包括：患者的一般资料、治疗、戒烟情况、调查前1年急性加重情况,慢性阻塞性肺疾病评估测试（CAT）问卷评分,改良的英国医学研究委员会呼吸困难量表（mMRC）。结果系统教育组戒烟成功率为97.6%,单纯随访组81.0%,对照组73.8%,系统教育组戒烟成功率高于单纯随访组和对照组（P〈0.01）。系统教育组和单纯随访组应用吸入支气管舒张剂治疗者为97.6%和93.7%,高于对照组的65.5%（P〈0.01）。应用祛痰药者分别为14.5%和19.0%,低于对照组的36.9%（P〈0.01）。系统教育组和单纯随访组过去1年急性加重次数为（0.9±0.9）次,低于对照组的（1.2±1.0）次（P〈0.05）。系统教育组和单纯随访组CAT分值为10.2±5.7和11.1±5.8,mMRC为1.5±1.0和1.5±0.9,均显著低于对照组的15.0±6.6和1.9±1.1（P〈0.01）。结论长期系统教育管理模式可以提高戒烟成功率和吸入支气管舒张剂使用率,有效地减少慢阻肺患者的急性加重,改善生活质量。

Long-term Management Program Can Improve Control Status of Stable COPD

Objective To evaluate the effect of long-term systemic education management program on intervention of chronic obstructive pulmonary disease（ COPD）. Methods Two hundred forty-six stable patients were interviewed face-to-face from March to August in 2013. They were divided into a systemic education group,a follow-up group and a control group according to different management program. The investigation contained general conditions,commonly used medicines,the effects of smoking cessation,the frequency of acute exacerbation in the year before investigation,COPD Assessment Test（ CAT） and modified British Medical Research Council（ mMRC）. Results The success rate for smoking cessation in the systemic education group was 97. 6%,which was higher than 81. 0% in the follow-up group and 73. 8% in the control group（ P 〈 0. 01）. 97. 6% of patients in the systemic education group and 93. 7% of patients in the follow-up group used bronchodilator. Whereas only 65. 5% of patients in the control group inhaled bronchodilator,significantly lower than other two groups（ P 〈 0. 01）. Mucolytic agents were taken by 14. 5% and 19. 0% of patients in the systemic education group and the follow-up group,and by 36. 9% of patients in the control group（ P 〈 0. 01）. The frequency of acute exacerbation was 0. 9 ± 0. 9 both in the systemic education group and the follow-up group,which was lower than 1. 2 ± 1. 0 in the control group（ P 〈 0. 05）. CAT and mMRC in the systemic education group（ 10. 2 ± 5. 7 and 1. 5 ± 1. 0） and the follow-up group（ 11. 1 ± 5. 8 and 1. 5 ±0. 9） were significantly lower than those in the control group（ 15. 0 ± 6. 6 and 1. 9 ± 1. 1,P 〈 0. 01）.Conclusions Long-term systemic education management program can improve success rate for smoking cessation and bronchodilator use,reduce the frequency of acute exacerbation,and improve quality of life effectively in COPD patients.