延续性护理对慢性阻塞性肺疾病患者肺功能及生活质量的影响研究

目的探讨延续性护理对慢性阻塞性肺疾病患者肺功能及生活质量的影响。方法选择本院接诊的90例慢性阻塞性肺疾病患者,通过随机数表法分为观察组和对照组,各45例。对照组在住院期间及出院时进行健康教育,出院后不再进行任何干预;观察组在对照组基础上给予延续性护理。护理3个月后,评价护理效果。结果护理后,观察组动脉血氧分压[p(O2)]、动脉血二氧化碳分压[p(CO2)]均优于对照组(P0.05);观察组1秒钟用力呼气容积(FEV1)、最大呼气中段平均流速(MMEF)、用力肺活量(FVC)高于对照组(P0.05);观察组呼吸症状、疾病对生活影响优于对照组(P0.05);观察组总体健康、生理功能、生理职能、躯体疼痛、活力、社会功能、情感职能、精神健康结果均优于对照组(P0.05)。结论在慢性阻塞性肺疾病患者中给予延续性护理,可有效促进肺功能的恢复,并改善生活质量,值得应用推广。     

四化护理模式在慢性阻塞性肺疾病中的干预效果及对患者生活质量的影响

目的 探讨四化护理模式在慢性阻塞性肺疾病中的干预效果及对患者生活质量的影响.方法 选取我院2019年1月至2020年12月收治的200例慢性阻塞性肺疾病患者作为研究对象,将其随机分为观察组(100例,四化护理模式+常规护理干预)和对照组(100例,常规护理干预).比较两组的肺功能指标、生活质量评分及护理满意度.结果 干...     

The effect of a pulmonary rehabilitation programme on older patients with chronic pulmonary disease

Aim. The aim of this study was to answer the question: is there an effect on the respiratory capacity and activity tolerance of older patients with chronic obstructive pulmonary disease who participate in a pulmonary rehabilitation programme? Background. Pulmonary rehabilitation is now an integral part of chronic obstructive pulmonary disease management. Evidence supports the positive effects of breath training and exercising training on quality of life, exercise tolerance and improved physical condition of individual with chronic obstructive pulmonary disease. Limited empirical documentation exists to support the effectiveness of a nurse managed rehabilitation programme for older patients with chronic obstructive pulmonary disease. The study was done to evaluate the effects of pulmonary rehabilitation provided by nurses on the pulmonary function, gas exchange and exercise tolerance in older patients with chronic obstructive pulmonary disease. Design. A one group pre‐test–post‐test design was used to evaluate the effects of a pulmonary rehabilitation programme. Method. The sample consisted of 20 patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation programme including breathing exercises, upper‐limb exercises and inspiratory muscle training. Results. The findings indicated improvement in exercise performance and a decrease in dyspnea after participation in the pulmonary rehabilitation programme. Relevance to clinical practice. The clinical nurse can make a significant impact on the illness trajectory and quality of life for patients with chronic obstructive pulmonary disease. The nurse has a critical role in helping patient with chronic obstructive pulmonary disease learn to cope, adjust and adapt to life with a chronic illness. Active nurse involvement with a patient in a pulmonary rehabilitation programme can assist in the identification of factors that motivate the patient, help in establishing realistic out comes expectations and provide patient teaching opportunities. The nurse can assist the patient to develop skills of self‐awareness regarding particular symptoms, self‐monitoring and health status change identification.     

整体护理模式对改善阻塞性肺气肿性心脏病患者行为方式的效果

目的探讨整体护理模式对改善阻塞性肺气肿性心脏病患者行为方式的临床效果。方法选择阻塞性肺气肿性心脏病患者196例,随机分为2组,每组各98例。对照组患者实施常规护理,观察组患者实施整体护理。对2组患者出院后行为方式进行统计,并采用生活质量量表对2组患者生活质量进行评价。结果观察组患者能够做到戒烟、按时服药、家庭氧疗、适度锻炼以及合理饮食者比例均显著高于对照组(P0.05)。观察组患者焦虑、抑郁、日常生活能力以及社会活动能力得分显著低于对照组(P0.05)。结论对阻塞性肺气肿性心脏病患者进行整体护理有利于改善患者的行为方式,并可提高患者的生活质量,是一种科学的护理模式。     

Diagnosis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease affects more than 26 million adults in the United States. Family physicians provide care for most of these patients. Cigarette smoking is the leading risk factor for chronic obstructive pulmonary disease, although other risk factors, including occupational and environmental exposures, account for up to one in six cases. Patients presenting with chronic cough, increased sputum production, or progressive dyspnea should be evaluated for the disease. Asthma is the disease most often confused with chronic obstructive pulmonary disease. The diagnosis of chronic obstructive pulmonary disease is based on clinical suspicion and spirometry confirmation. A forced expiratory volume in one second/forced vital capacity ratio that is less than 70 percent, and that is incompletely reversible with the administration of an inhaled bronchodilator, suggests chronic obstructive pulmonary disease. Disease severity is classified by symptomatology and spirometry. Joint guidelines from the American Thoracic Society and the European Respiratory Society recommend a single quantitative test for alpha1-antitrypsin deficiency in patients diagnosed with chronic obstructive pulmonary disease who remain symptomatic despite bronchodilator therapy. Other advanced testing is usually not necessary.     

Strategies for screening for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is easily detected in its preclinical phase, using office spirometry. Successful smoking cessation prevents further disease progression in most patients. Spirometry measures the ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV(1)/FVC), which is the most sensitive and specific test for detecting airflow limitation. Primary care practitioners see the majority of adult smokers, but few primary care practitioners currently have spirometers or regularly order spirometry for their smoker patients. Improvements in spirometry software have made it much easier to obtain good quality spirometry test sessions, thereby reducing the misclassification rate. Respiratory therapists and pulmonary function technologists can help primary care practitioners select good office spirometers for identifying chronic obstructive pulmonary disease and teach staff how to use spirometers correctly.     

综合护理干预在老年 COPD 稳定期患者中的应用

目的：探讨综合护理干预在老年COPD稳定期患者中的应用效果。方法选择2009年10月-2011年9月收治的老年COPD患者82例作为对照组,选择2011年10月-2013年5月收治的老年COPD患者71例作为观察组,对照组患者给予常规护理,观察组在常规护理的基础上进行综合护理干预,主要包括健康教育、心理干预、营养指导、康复训练和跟踪指导。出院6月后,观察两组的血气分析、肺功能和生活质量情况。结果干预前两组患者血气分析、肺功能指标及生活质量各项评分比较差异均无统计学意义（P ＞0．05）;干预后,观察组患者 PaO2为（94．6±5．2） mmHg、PaCO2为（37．8±4．0）mmHg,对照组的分别为（87．5±4．8）,（45．7±3．9）mmHg,观察组的血气分析改善优于对照组,两组,差异具有统计学意义（ t值分别为2．556,3．014;P＜0．05）;观察组患者的肺功能指标一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大肺活量（VCmax）、最大呼气流速峰值分别为（1．70±0．21）L、（2．49±0．31）L、（3．24±0．82）L和（4．56±1．83）％,对照组的分别为（1．63±0．20）L、（2．30±0．26）L、（2．89±0．80）L和（3．52±1．64）％,观察组患者的肺功能指标优于对照组,两组差异具有统计学意义（t值分别为2．173,2．355,2．965,3．284;P＜0．05）;观察组患者的日常生活、社会活动、抑郁和焦虑评分分别为（32．82±1．68）,（16．59±1．84）,（15．24±1．75）,（15．69±2．21）分,对照组分别为（41．96±2．13）,（22．59±2．42）,（22．47±2．29）,（22．86±2．32）分,观察组的生活质量指标改善均优于对照组,两组差异亦具有统计学意义（t值分别为3．526,3．278,3．360,3．297;P＜0．05）。结论综合护理干预对老年慢性阻塞性肺病稳定期患者的血气分析和肺功能改善均有积极意义,并能够显著提高患者的生活质量,值得在临床推广应用。     

Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study

Title. Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study Aim. This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. Background. Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. Methods. We conducted qualitative interviews of eight people with COPD and collected data over a 2‐month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. Findings. Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. Conclusion. Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family‐centred support may be most effective.     

Chronic obstructive pulmonary disease: diagnostic considerations

Chronic obstructive pulmonary disease is characterized by the gradual progression of irreversible airflow obstruction and increased inflammation in the airways and lung parenchyma that is generally distinguishable from the inflammation caused by asthma. Most chronic obstructive pulmonary disease is associated with smoking, but occupational exposure to irritants and air pollution also are important risk factors. Patients with chronic obstructive pulmonary disease typically present with coughing, sputum production, and dyspnea on exertion. However, none of these findings alone is diagnostic. The Global Initiative for Chronic Obstructive Lung Disease diagnostic criterion for chronic obstructive pulmonary disease is a forced expiratory volume in one second/forced vital capacity ratio of less than 70 percent of the predicted value. Severity is further stratified based on forced expiratory volume in one second and symptoms. Chest radiography may rule out alternative diagnoses and comorbid conditions. Selected patients should be tested for alpha1-antitrypsin deficiency. Arterial blood gas testing is recommended for patients presenting with signs of severe disease, right-sided heart failure, or significant hypoxemia. Chronic obstructive pulmonary disease also is a systemic disorder with weight loss and dysfunction of respiratory and skeletal muscles.     

无创通气联合莫西沙星对慢性阻塞性肺病合并呼吸衰竭患者预后的影响

目的探讨无创通气联合莫西沙星对慢性阻塞性肺病合并呼吸衰竭患者预后的影响。方法选取72例慢性阻塞性肺病合并呼吸衰竭患者,随机分为观察组(常规治疗+无创通气+莫西沙星)和对照组(常规治疗+无创通气)。比较2组患者预后指标的改善情况。结果观察组总有效率、细菌清除率、p H、p(CO2)、p(O2)、FEV1、APACHEⅡ、生活质量评分均显著优于对照组(P0.05)。结论无创通气联合莫西沙星治疗慢性阻塞性肺病合并呼吸衰竭患者疗效显著。     

慢性阻塞性肺病患者社区康复模式的探讨

目的探讨适合慢性阻塞性肺病患者的社区康复护理模式。方法将100例社区慢性阻塞性肺病患者随机分为干预组和对照组各50例。对照组仅实施常规康复指导,而对干预组执行一套为期8周的家庭访视关键流程,并进行跟踪随访。1年后,应用肺功能和生活质量评估量表对2组患者进行评价。结果干预组与对照组比较,反映肺功能的FVC(L)、FEV(1L)、FVC/预计值(%)、FEV1/预计值(%)指标差异均有统计学意义。在反映生活质量的日常生活、社会活动、抑郁、焦虑4个因子的对比中,2组差异也有统计学意义(P<0.05)。结论以“合理营养、劝导戒烟、心理支持、活动指导”为干预重点,并将健康教育贯穿其中的社区康复模式,能有效延缓COPD的病情发展,减低COPD转归为肺心病及呼吸衰竭的发病率,提高患者的生存质量。     

Performance changes for patients with chronic obstructive pulmonary disease on long-term oxygen therapy after physiotherapy.

OBJECTIVE: To investigate whether patients with chronic obstructive pulmonary disease on long-term oxygen therapy would benefit from an early 8-week rehabilitation programme in terms of exercise performance, health-related quality of life and activities of daily living. METHODS: Two weeks after onset of oxygen therapy, 20 patients were randomized to rehabilitation (group A) or not (group B). Exercise performance was measured using a 6-minute walking test. Health-related quality of life was measured with the Chronic Respiratory Disease Questionnaire. Activity of daily living ability was measured with the Stanford Health Assessment Questionnaire. RESULTS: The mean 6-minute walking distance increased by 35% (p < 0.01) in group A after rehabilitation. The mean increase in group B was only 8% (n.s.). Patients in group A reported less overall dyspnoea after rehabilitation (p < 0.05) and, compared with group B, reported better activity of daily living ability (p < 0.01). CONCLUSION: Patients with chronic obstructive pulmonary disease on long-term oxygen treatment may improve their walking distance, experience less dyspnoea and improve activity of daily living ability with an early rehabilitation programme.     

Outpatient pulmonary rehabilitation. A new lease on life

For patients with restrictive as well as obstructive disease, pulmonary rehabilitation offers a comprehensive program that affects all areas of their life. Marked improvement is seen in exercise tolerance and in performing all activities of daily living. Compliance with drug therapy and other prescribed treatment also improves. The isolation, depression, and irritability that so often accompany respiratory disease are alleviated by ongoing membership in patient support groups. Patients again become active participants in life.     

Effectiveness of non-invasive positive pressure ventilation differs between decompensated chronic restrictive and obstructive pulmonary disease patients

OBJECTIVE: To compare the efficiency of non-invasive positive pressure ventilation (NPPV) in decompensated patients with either chronic obstructive pulmonary disease (COPD) or chronic restrictive pulmonary disease. DESIGN: Retrospective study. SETTING: A 17-bed intensive care unit in a university teaching hospital. SETTING: Sixty-four patients with COPD (age: 70+/-13 years, sex ratio: 37 male to 27 female patients, forced expiratory volume in 1 s: 31+/-13% predicted) and 20 patients with chronic restrictive pulmonary disease (age: 75+/-9 years, sex ratio: 9 male to 11 female patients, total lung capacity: 57+/-17% predicted) consecutively treated with NPPV (facial mask, pressure support ventilation (PSV) +/- PEEP) for acute respiratory failure. MEASUREMENTS AND RESULTS: There were no statistically significant differences between COPD and patients with chronic restrictive pulmonary disease in terms of cause of exacerbation, use of oxygen therapy or NPPV at home, severity of acute respiratory failure (ARF), mean delay from intensive care admission to initiation of NPPV and total duration of NPPV. Patients with chronic restrictive pulmonary disease had a lower success rate on NPPV (without need of tracheal intubation) than COPD (35% vs 67%, p=0.01). Causes of NPPV failure were not different between COPD and patients with restrictive disease. After 12 h of NPPV, restrictive patients who succeeded with NPPV had similar respiratory rate, minute ventilation and arterial blood gas to COPD patients. At the 3rd and 12th h of NPPV, improvements in pH and PaCO(2) were predictive of NPPV success in COPD, but not in restrictive patients. CONCLUSION: The results of this retrospective study suggest that the effectiveness of NPPV for acute decompensation is less in patients with chronic restrictive pulmonary disease as compared to COPD.     

慢性阻塞性肺疾病患者运动能力与生活质量的相关性研究

目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者运动能力、生活质量现状及相关性。方法:2018年9月至2019年5月对复旦大学附属中山医院154例COPD患者进行横断面调查,采用6 min行走距离(six-minute walk distance,6 MWD)评估患者运动能力,使用一般资料调查表、圣·乔治呼吸问卷(SGRQ)进行调查分析。结果:患者6 MWD为(379.65±121.05)m; SGRQ问卷得分为(42.12±17.54)分;6 MWD与SGRQ得分负相关,差异有统计学意义(r=-0.422,P0.001);患者的年龄、体质量指数(BMI)、吸烟指数、疾病严重程度和6 MWD对生活质量(SGRQ得分)有影响;6 MWD、高龄、吸烟指数和BMI是患者生活质量水平的影响因素。结论:COPD患者生活质量、运动能力处于较低水平。生活质量与运动能力、年龄、BMI等显著相关。     

应用电子健康档案实施COPD患者的延续护理

目的:探讨应用电子健康档案对慢性阻塞性肺疾病(COPD)患者实施延续护理的方法及对其生活质量的干预效果。方法:采用自身前后对照的研究方法,共收集因COPD急性加重入院的患者55例,应用电子健康档案对其实施出院后的延续护理。在干预前及干预后的第1、第3、第6、第12个月收集患者肺功能及生活质量的相关数据。结果:患者的肺功能在干预前、后的比较差异无统计学意义(P>0.05);生活质量总分及其各因子在干预前、后的比较差异有统计学意义(P<0.01)。结论:电子健康档案的应用实现了对COPD患者出院后的延续护理及相关数据的动态管理与随访分析,提高了患者的生活质量。     

慢性阻塞性肺疾病病人生活质量的影响因素及护理干预现状

从一般人口学资料、疾病相关资料等方面综述了影响慢性阻塞性肺疾病病人生活质量的主要因素,并阐述了心理情绪干预、躯体功能干预、生活行为干预对提高慢性阻塞性肺疾病病人生活质量的作用.     

步行锻炼对COPD患者肺功能和生存质量的影响

目的 :探讨步行锻炼对慢性阻塞性肺疾病 (chronicobstructiveplumonarydisease,COPD)患者肺功能和生存质量的影响。方法 :28例轻、中度COPD患者每天进行30min以上的匀速步行锻炼 ,持续2个月 ,锻炼前后分别测试肺功能指标 (FVC、FEV1、%FVC、?V1、FEV1/FVC % )和评估生存质量。结果 :COPD患者锻炼后肺功能指标无明显差异 (P均>0.05) ,但生存质量评分明显优于锻炼前 (P均>0.05)。结论 :生存质量指标评估肺康复更敏感。     

家庭护理干预对提高慢性阻塞性肺疾病患者生活质量和肺功能的影响

目的 探讨家庭护理干预对提高慢性阻塞性肺疾病(COPD)患者生活质量和肺功能的效果.方法 将72例COPD患者随机分为实验组与对照组各36例,2组均接受常规的治疗和护理.对实验组患者及家属额外进行家庭护理干预,并对干预后2组患者生活质量及肺功能进行评定.结果实验组在家庭护理干预后生活质量评估和肺功能指标较干预前均有明显改善(P＜0.05);对照组患者的生活质量和肺功能则无显著改善(P＞0.05).结论 有效的家庭护理能提高COPD患者的生活质量和肺功能.     

社区戒烟督导对老年慢性阻塞性肺疾病患者肺功能及生活质量的影响

目的 探讨老年慢性阻塞性肺疾病(COPD)缓解期患者社区戒烟干预对肺功能、急性发作次数、生活质量的影响.方法 选择2006年10月-2007年10月诊视的稳定期COPD患者45例,将入选患者随机分为干预组(23例)和对照组(22例).对照组患者予以常规的药物治疗,干预组除常规药物治疗外,测评干预前后患者的肺功能状况、生活质量(圣乔治呼吸问卷,SGRQ)及年急性发作次数的变化.结果 干预后患者肺功能改善情况及生活质量显若优于干预前,P<0.05.结论 社区戒烟督导干预是有效改善COPD患者肺功能、生活质世、减少急性发作的可行措施.