慢性阻塞性肺病患者治疗依从性对生活质量的影响

目的：探讨慢性阻塞性肺疾病患者治疗依从性对生活质量的影响。方法：选择2006年1月至2006年12月于北京安贞医院呼吸内科门诊就诊的慢性阻塞性肺疾病患者共187例，在门诊就诊期间以诺丁汉健康调查问卷和西雅图阻塞性肺疾病问卷对患者进行调查。结果：有173例患者接受了问卷的调查。2份生活质量问卷的信度分析显示其内部一致性系数分别为0．85、0．77。2份生活质量问卷的结构效度分析显示存在不同程度的统计学相关性。根据患者依从性分成高依从性组（共86例），低依从性患者（共87例），两组患者诺丁汉健康调查问卷总分及其各个亚组和西雅图阻塞性肺疾病问卷总分及其各个亚组得分差异均存在显著差异性（P均〈0．01）。结论：患者的治疗依从性是影响慢性阻塞性肺疾病患者生活质量的因素。     

糖尿病患者冠状动脉旁路移植术后的生命质量评价

目的 运用西雅图心绞痛问卷和杜克活动问卷对冠状动脉旁路移植术后DM患者的生命质量进行评价。方法对2001年1月至2002年1月于北京大学人民医院心脏外科接受冠状动脉旁路移植手术的患者273例进行生命质量问卷调查,对问卷进行信度和效度的评价。结果共有DM患者52例;两个生命质量问卷的信度分析结果内部一致性系数分别为0．81、0．75,结构效度分析结果显示存在不同程度的统计学相关性。DM组与非DM组的西雅图心绞痛问卷总分及各亚组得分均不存在统计学差异,两组间杜克活动问卷总分、VO2PEAK得分、MET得分均存在统计学差异（P均＜0．05）。结论糖尿病可能是影响冠状动脉旁路移植术后患者生命质量的因素。     

慢性阻塞性肺疾病患者DOSE指数与生活质量的相关性

目的探讨慢性阻塞性肺疾病患者DOSE指数与生活质量的相关性。方法采用一般资料调查表、DOSE指数、慢性阻塞性肺疾病临床问卷对103例住院慢性阻塞性肺疾病患者进行调查。结果慢性阻塞性肺疾病患者DOSE指数得分(3. 33±1. 83)分,慢性阻塞性肺疾病临床问卷总得分(2. 73±1. 33)分,DOSE指数与症状维度得分、功能状态维度得分、慢性阻塞性肺疾病临床问卷总得分呈正相关(r=0. 213~0. 471,P0. 05)。结论护理人员应积极运用DOSE指数,预测慢性阻塞性肺疾病患者的生活质量,并将其作为评价生活质量变化的客观依据。     

"中国心血管病人生活质量评定问卷"的初步应用体会

目的：探讨“中国心血管病人生活质量评定问卷”（CCQQ）评价心血管患者生活质量的价值。方法：选择2008年1月至2008年3月在北京安贞医院心内科和北京大学人民医院心脏中心就诊的心血管患者共600例，使用“中国心血管病人生活质量评定问卷”和健康调查简表（SF-36）进行生活质量的评价并进行比较。结果：两个问卷在所有患者、高血压患者、冠心病患者以及心衰患者中均具有较好的信度（Cronbach’s α因子〉0．7），和较好的效度（r=0．278～0．674，P〈0．01）。结论：CCQQ在心血管患者中有较好的信度和效度，初步效果较好，有待进一步验证。     

性别对慢性心力衰竭患者生活质量和社会支持的影响

目的：探讨性别对慢性心力衰竭（CHF）患者生活质量和社会支持的影响。方法：采用横断面研究方法,以问卷调查方式分别使用简明健康调查问卷、明尼苏达心力衰竭生活质量问卷和社会支持评判量表对CHF患者的生活质量及社会支持度进行调查。结果：（1）生活质量：①简明健康调查问卷：除生理职能、躯体疼痛维度外,总分和其余6个维度分女性组均明显低于男性组（P〈0．05～〈0．001）;②明尼苏达心力衰竭生活质量问卷：在身体领域、情绪领域、其他领域分和总分方面,女性组的均明显高于男性组的（P〈0．001）;（2）社会支持度：除主观支持维度分外,客观支持、对支持利用度分以及总分女性组明显低于男性组（P〈0．05）。结论 慢性心衰患者在生活质量及社会支持方面存在性别差异,女性患者明显低于男性患者。     

45例慢性阻塞性肺疾病的社区护理体会

目的探讨慢性阻塞性肺疾病的社区护理方法及疗效。方法对集仕港社区内敬老院及居家生活的45例慢性阻塞性肺疾病患者及其家属进行系统的社区护理，并比较实施社区护理前后各一年内患者的急性发作次数、住院时间及肺功能测定情况。结果接受社区护理的患者急性发作次数明显减少，住院天数下降（P〈0．05），FEV1／FVC％、FEV1％PRED变化不明显（P〉0．05）。结论正确开展社区护理对防治慢性阻塞性肺疾病的急性发作，改善患者的生活质量有较好的作用，值得推广。     

沙美特罗替卡松粉吸入剂治疗中度慢性阻塞性肺疾病稳定期的临床疗效观察

目的探究沙美特罗替卡松粉吸入剂治疗中度慢性阻塞性肺疾病稳定期的临床疗效。方法选取2011年4月—2012年12月武汉市武东医院收治的中度慢性阻塞性肺疾病稳定期患者91例,根据入院序列号分为对照组45例和研究组46例。对照组患者给予常规祛痰、平喘治疗,研究组患者在对照组基础上给予沙美特罗替卡松粉吸入剂治疗。比较两组患者治疗前后肺功能指标〔呼气峰值流速（PEF）、用力肺活量（FVC）、第一秒用力呼气容积（FEV1）/FVC〕、圣乔治呼吸问卷（SGRQ）评分（包括症状评分、疾病影响评分、活动评分和总分）。随访1-2年,比较两组患者慢性阻塞性肺疾病急性发作次数。结果治疗前两组患者PEF、FVC、FEV1/FVC比较,差异无统计学意义（P〉0.05）;治疗后研究组患者PEF、FVC、FEV1/FVC均高于对照组（P〈0.05）。治疗前两组患者症状评分、疾病影响评分、活动评分及SGRQ总分比较,差异无统计学意义（P〉0.05）;治疗后研究组患者症状评分、疾病影响评分、活动评分及SGRQ总分均低于对照组（P〈0.05）。全部患者平均随访（1.63±0.12）年,研究组患者慢性阻塞性肺疾病急性发作次数为（0.49±0.13）次,少于对照组的（1.49±0.37）次（P〈0.05）。结论沙美特罗替卡松粉吸入剂治疗中度慢性阻塞性肺疾病稳定期患者的临床疗效确切,能有效改善患者的肺功能,减少慢性阻塞性肺疾病急性发作次数。     

门诊老年慢性阻塞性肺疾病患者精神心理因素分析

目的 探讨门诊老年慢性阻塞性肺疾病患者精神心理因素及社会支持情况.方法 采用统一的指导语,运用症状自评量表(SCL-90)及社会支持评定量表(SSRS)对264例老年慢性阻塞性肺疾病患者(观察组)和142例健康志愿者(对照组)进行调查.结果 门诊老年慢性阻塞性肺疾病患者躯体化、强迫症状、焦虑、恐怖、抑郁、精神病性因子及SCL-90阳性项数的均数等指标均明显高于对照组(P<0.05或P<0.01);SSRS评定门诊老年慢性阻塞性肺疾病患者的客观、主观支持及支持总分均明显低于对照组(P<0.05或P<0.01).结论 门诊老年慢性阻塞性肺疾病患者病后心理健康状况较差,社会支持低.因此,在进行躯体治疗的同时应实施心理干预.     

慢性阻塞性肺疾病患者接受辅助检查和问卷评估的现状分析

目的客观评价目前慢性阻塞性肺疾病（COPD）患者诊治依从性现状,为改进COPD患者的长期管理策略提供线索和依据。方法选择2011年9月到2012年4月间在我院专病门诊就诊的COPD患者,测评患者对医务人员要求其执行的辅助检查及病情评估问卷项目完成的情况。结果共有143名COPD患者完成测评,仅13．29％患者完成全部检查和问卷评估。患者对检查评估的接受程度（42．28％）高于对问卷评估的接受程度（3．25％）（P〈0．001）,接受规范化治疗的患者对检查和问卷评估的接受程度（30．56％）较不接受规范化治疗的患者高（7．48％）（P〈0．001）。结论COPD患者对检查和问卷评估的接受程度较低,提高患者对疾病的认知水平是改善和实现新的GOLD策略下COPD管理的可能途径之一。     

长期小剂量阿奇霉素联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病的临床研究

目的：研究小剂量阿奇霉素联合舒利迭（沙美特罗替卡松粉吸入剂）在稳定期中重度慢性阻塞性肺疾病患者中长期应用的临床疗效和安全性.方法：选取我院呼吸科门诊诊治的Ⅱ~Ⅲ级慢性阻塞性肺疾病患者84例,随机分为对照组、治疗组各42例,对照组给予舒利迭吸入,治疗组联用阿奇霉素0.25g口服,1次/d,观察治疗4个月后肺功能（FEV1%）、6min步行距离、呼吸困难评分及慢性阻塞性肺疾病急性加重频率的变化.结果：两组患者肺功能、6min步行距离、呼吸困难评分均有改善,治疗组更为明显（P〈0.05）,治疗组慢性阻塞性肺疾病急性加重次数明显少于对照组（P〈0.05）.结论：长期小剂量阿奇霉素联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病可提高患者生活质量、减少慢性阻塞性肺疾病急性加重次数、延缓病情进展,值得临床推广.     

The relationship between physical, functional capacity and quality of life (QoL) among elderly people with a chronic disease

The aim of this study was to evaluate the relationship between physical and functional capacity and quality of life (QoL) among elderly people who have a chronic disease. The study included 100 elderly individuals aged 65 years and older, who have a chronic disease. The study examined the marital and educational status, social security status, kind of chronic disease, number of chronic diseases and whether participants use assistive devices for walking. The Nottingham health profile (NHP) was used to evaluate QoL related to health; the physical mobility scale (PMS) was used to evaluate mobility in daily life and the functional independent measure (FIM) was used to evaluate functional independence in daily activities. In both female and male individuals, a statistically significant difference was found between the number of chronic diseases, kind of chronic disease, educational status, marital status, total FIM, PMS and NHP values (p < 0.05). In males, there was a correlation between number of chronic illnesses and total NHP, FIM (p < 0.05), but in females, there were no correlation between number of chronic illnesses and total NHP, FIM (p > 0.05). There were no correlations between kind of chronic disease and PMS, NHP, FIM (p > 0.05) in either of genders. It was found that there are differences among elderly female and male individuals with a chronic disease in terms of the number of chronic diseases, types of chronic disease, mobility level, functional status and QoL; and mobility level is related to functional capacity and QoL in females. It is thought that the rehabilitation programs to improve physical and functional capacity in elderly people and applications that increase participation in activities and reduce pain may improve QoL.     

The relationship between physical,functional capacity and quality of life (QoL) among elderly people with a chronic disease

The aim of this study was to evaluate the relationship between physical and functional capacity and quality of life (QoL) among elderly people who have a chronic disease. The study included 100 elderly individuals aged 65 years and older, who have a chronic disease. The study examined the marital and educational status, social security status, kind of chronic disease, number of chronic diseases and whether participants use assistive devices for walking. The Nottingham health profile (NHP) was used to evaluate QoL related to health; the physical mobility scale (PMS) was used to evaluate mobility in daily life and the functional independent measure (FIM) was used to evaluate functional independence in daily activities. In both female and male individuals, a statistically significant difference was found between the number of chronic diseases, kind of chronic disease, educational status, marital status, total FIM, PMS and NHP values (p < 0.05). In males, there was a correlation between number of chronic illnesses and total NHP, FIM (p < 0.05), but in females, there were no correlation between number of chronic illnesses and total NHP, FIM (p > 0.05). There were no correlations between kind of chronic disease and PMS, NHP, FIM (p > 0.05) in either of genders. It was found that there are differences among elderly female and male individuals with a chronic disease in terms of the number of chronic diseases, types of chronic disease, mobility level, functional status and QoL; and mobility level is related to functional capacity and QoL in females. It is thought that the rehabilitation programs to improve physical and functional capacity in elderly people and applications that increase participation in activities and reduce pain may improve QoL.     

老年冠心病患者在冠状动脉旁路移植术后生命质量的研究

目的评价不同性别老年冠心病患者在冠状动脉旁路移植术后的生命质量。方法采用诺丁汉健康调查问卷、西雅图心绞痛问卷和杜克活动问卷形式对我院接受冠状动脉旁路移植术后出院的273例患者进行问卷调查。依据年龄分为老年组(166例)和对照组(107例)。结果男性患者中,3份生命质量量表,对照组患者生命质量均优于老年组患者(P<0.05),其中在活动受限、治疗满意程度、疾病的主观感受、精力、疼痛、情绪反应、睡眠、社会孤独感、活动能力存在统计学差异(P<0.05)。女性患者中,3份生命质量量表,对照组患者生命质量也均优于老年组患者(P<0.05,P<0.01),其中在活动受限、治疗满意程度存在统计学差异(P<0.05,P<0.01)。结论冠状动脉旁路移植术后老年冠心病患者生命质量明显减低,其中男性更明显。     

Determinants for an impaired quality of life 10 years after coronary artery bypass surgery

OBJECTIVE: To identify determinants of an inferior quality of life (QoL) 10 years after coronary artery bypass grafting (CABG). SETTING: Sahlgrenska University Hospital, G?teborg, Sweden. PARTICIPANTS: All patients from Western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery and no previous CABG. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL 10 years after the operation. Three different instruments were used: The Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the Physical Activity Score (PAS). RESULTS: 2000 patients underwent CABG, of whom 633 died during 10 years of follow-up. Information on QoL at 10 years was available in 976 patients (71% of survivors). A history of diabetes and chronic obstructive pulmonary disease were the two independent predictors for an inferior QoL with all three instruments. Furthermore, there were three predictors of an inferior QoL with two of the instruments: high age, female sex and a history of hypertension. A number of factors predicted an inferior QoL with one of the instruments. These were the duration of angina pectoris and functional class prior to CABG, renal dysfunction, a history of cerebrovascular disease, obesity, height, duration of respirator treatment and requirement of inotropic drugs postoperatively. In addition, when introducing preoperative QoL into the model a low QoL before surgery was a strong independent predictor also of an inferior QoL 10 years after CABG. CONCLUSION: Variables independently predictive of an impaired QoL 10 years after CABG, irrespective of the instrument used, were an impaired QoL prior to surgery, chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, the previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.     

First study of infliximab treatment in patients with chronic obstructive pulmonary disease

RATIONALE: Tumor necrosis factor-alpha is believed to be important in the induction and maintenance of airway inflammation in chronic obstructive pulmonary disease. OBJECTIVES: We aimed to evaluate the effect of the anti-tumor necrosis factor-alpha drug infliximab in patients with chronic obstructive pulmonary disease, with percentage of sputum neutrophils as the primary endpoint. METHODS: We performed an exploratory single-center, double-blind, placebo-controlled, randomized, phase 2 trial in which 22 current smokers with mild-to-moderate chronic obstructive pulmonary disease participated. Fourteen patients received three infusions of infliximab (5 mg/kg) at Weeks 0, 2, and 6, and eight patients received placebo infusions. Sputum samples, respiratory symptoms, quality of life, exhaled nitric oxide, lung function parameters, bronchial hyperresponsiveness, resting energy expenditure, and side effects were evaluated. MEASUREMENTS AND MAIN RESULTS: This study did not show a positive short-term effect of infliximab on airway inflammation, lung function, resting energy expenditure, or quality of life. Exhaled nitric oxide increased significantly at Day 2, Week 6, and Week 8 in patients receiving infliximab compared with those receiving placebo. Eight patients in the infliximab group (vs. none in the placebo group) reported increased coughing, but no serious adverse events or increase in respiratory infections were reported during 9 weeks of follow-up. CONCLUSIONS: In this short-term study, no clinically beneficial effects of infliximab were observed, and there were no significant safety issues. Definite conclusions concerning the effectiveness of infliximab treatment in chronic obstructive pulmonary disease await additional studies, including those with a larger number of patients with more advanced disease.     

老年高血压患者性别差异的相关性研究

目的探讨老年高血压患者的性别差异。方法通过随机整群抽样的方法,选择西安局部地区老年高血压患者329例,其中男性185例,女性144例。对不同性别老年高血压患者进行一般人口学特征、慢性病、辅助检查及心理健康等调查,并比较和分析影响因素。结果男性与女性老年高血压患者在教育程度、吸烟、饮酒、慢性阻塞性肺病、骨关节病、空腹血糖、TG、TC、HDL-C、LDL-C、尿酸、肌酐、抑郁症状等方面比较,差异有统计学意义(P<0.05,P<0.01)。生活不规律、受教育程度是男性老年高血压患者的影响因素(OR=1.609,95%CI:1.018².542,P=0.042;OR=0.678,95%CI:0.5532.542,P=0.042;OR=0.678,95%CI:0.553⁰.832,P=0.000),高TG、受教育程度是女性老年高血压患者的影响因素(OR=1.486,95%CI:1.1310.832,P=0.000),高TG、受教育程度是女性老年高血压患者的影响因素(OR=1.486,95%CI:1.131¹.950,P=0.004;OR=0.710,95%CI:0.5971.950,P=0.004;OR=0.710,95%CI:0.597⁰.844,P=0.000)。结论受教育程度是男性和女性老年高血压患者共同保护因素。男性影响因素为生活不规律,女性为高TG。     

慢性阻塞性肺疾病评估测试对生存质量的评估价值研究

目的探讨慢性阻塞性肺疾病(COPD)评估测试(CAT)用于我国COPD患者生存质量的应用价值。方法选择2010年4月至2011年2月中国医科大学附属第一医院呼吸内科就诊和定期随访的COPD患者107例,其中男57例,女50例,年龄40～86岁,平均(67.4±9.8)岁。分别对患者进行中文版CAT和圣.乔治呼吸问卷(SGRQ)调查,同时进行肺功能测定。验证CAT的信度及效度,采用Spearman秩相关分析CAT评分与SGRQ评分、CAT评分与肺功能指标之间的相关性。结果 CAT的克龙巴赫α系数为0.796;CAT每个问题单项分值与总分值的Spearman秩相关系数为0.413～0.758(P<0.01);通过因子分析,最终抽取2个维度,可以解释总体方差的59.18%,各维度与量表总体的相关系数(0.960,0.549,P<0.01)大于维度间的相关系数(0.292)(P<0.01)。CAT总评分与SGRQ总评分呈显著正相关(r=0.735,P<0.01),第一秒用力呼气容积占预计值百分比(FEV1%)呈显著负相关(r=-0.441,P<0.01),与FEV1占用力肺活量(FVC)百分比(FEV1/FVC)亦呈显著负相关(r=-0.324,P<0.01)。结论中文版CAT是一种简易、可靠、有效的新型COPD患者生存质量评估问卷,可以很好地反映中国COPD患者的生存质量,适用于中国COPD患者的生存质量的评估。     

Determinants of an impaired quality of life five years after coronary artery bypass surgery

OBJECTIVE: To identify determinants of an inferior quality of life (QoL) five years after coronary artery bypass grafting (CABG). SETTING: University hospital. PARTICIPANTS: Patients from western Sweden who underwent CABG between 1988 and 1991. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL before CABG and five years after operation. Three different instruments were used: the Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the physical activity score (PAS). RESULTS: 2121 patients underwent CABG, of whom 310 died during five years' follow up. Information on QoL after five years was available in 1431 survivors (79%). There were three independent predictors for an inferior QoL with all three instruments: female sex, a history of diabetes mellitus, and a history of chronic obstructive pulmonary disease. Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease. CONCLUSIONS: Female sex, an impaired QoL before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.     

Change in generic and disease-specific health-related quality of life during a one-year period in patients with newly detected chronic obstructive pulmonary disease

BACKGROUND: Although the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) has been assessed by generic or disease-specific HRQoL measures, the responsiveness of the generic HRQoL measures is generally weak. OBJECTIVES: To investigate the responses generated by generic and disease-specific HRQoL questionnaires, we prospectively followed the clinical course of patients with newly detected COPD after the initiation of treatment. METHODS: A prospective, longitudinal study with a 1-year follow-up was designed. The forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), the Nottingham Health Profile (NHP) as a generic HRQoL measure, and the Chronic Respiratory Disease Questionnaire (CRQ) as a disease-specific HRQoL measure were measured at baseline and at 3, 6, and 12 months after the initiation of standard treatment. RESULTS: Eighty-two patients completed the study. The FEV(1), FVC, and NHP and CRQ scores improved significantly during the first 3 months (p < 0.05). During the last 6 months, although the FEV(1) declined (p < 0.05), the HRQoL assessed by the NHP and CRQ remained elevated. Except for the score on the social isolation section of the NHP at 12 months, all HRQoL scores at 6 and 12 months were significantly improved compared to baseline (p < 0.05). CONCLUSION: In new patients with COPD, the NHP as well as the CRQ was able to detect changes in the HRQoL associated with effective medical interventions. The influence of the changes in airflow limitation on the HRQoL was weak.