慢性阻塞性肺疾病稳定期患者生存质量与肺功能的关系

目的研究慢性阻塞性肺疾病(COPD)稳定期患者生存质量(QOL)与肺功能的关系。方法73例COPD稳定期患者,用生存质量量表评估并与肺功能结果进行多元回归分析。结果QOL总均分(1.64±0.36)与FEV1/FVC%(65.99±12.56)之间存有显著的直线负相关,相关系数为-0.36(P<0.01)。经多元线性相关分析肺功能各参数与量表不同因子之间存在某种相关性,它们均与抑郁症状均分呈显著负相关,相关系数分别为-0.779、-0.629、-0.888、-0.786、-0.337(P<0.01)。结论国内开发的量表与肺功能之间有良好的相关关系。此量表目前可作为评估COPD病情严重度的较好指标。     

老年慢性阻塞性肺疾病患者生存质量及其影响因素分析

目的　探讨老年慢性阻塞性肺疾病 (COPD)患者生存质量及其影响因素的关系。方法　用生活质量问卷表对 5 0 0例 6 0岁以上老年COPD患者进行调查 ,并用多元逐步回归方法对老年COPD患者生存质量的影响因素进行分析。结果　身体健康状态和日常生活能力是影响老年COPD患者生存质量的主、客观评价共有的第 1、2位因素 ,COPD是老年人身体患病率仅次于心血管疾病而位居第二位的老年慢性疾病。结论　加强老年COPD患者的健康教育和医疗保健 ,积极预防和治疗高血压、冠心病、骨关节疾病等老年常见病对提高老年COPD患者生存质量有显著作用。     

Psychological distress and quality of life in hospitalized patients with chronic obstructive pulmonary disease

BACKGROUND: Knowledge of what may influence patients' perceptions of quality of life is essential for improving nursing interventions, but there has been little research on the influence of psychological distress on health status and quality of life among patients with chronic obstructive pulmonary disease. AIM: This paper reports a study whose aim was to examine how disease factors and health status affect psychological distress and subjectively perceived quality of life in patients admitted for an acute exacerbation of chronic obstructive pulmonary disease. METHOD: A convenience sample of 92 inpatients (mean age 69 years) were interviewed using the St George's Respiratory Questionnaire, Hopkins Symptoms Check List (23 item version), and World Health Organization Quality of Life Assessment. Disease variables (disease duration and pulmonary function) and health status were entered in blockwise multivariate regression analyses to examine the relationships between disease variables, psychological distress, and a single item assessment of overall quality of life. RESULTS: The St George's Respiratory Questionnaire Total and Impact subscores showed statistically significant associations with psychological distress. Pulmonary function showed a moderately significant association with subjective perceived quality of life. Pulmonary function and disease duration explained a minor part of the variance in quality of life. Psychological distress had a statistically significant association with quality of life and accounted for 34% of the total 39% variance explained by our model. CONCLUSIONS: The influence of psychological distress on quality of life implies that bringing about change in psychological distress factors may have important consequences for quality of life. The findings should be taken seriously in developing future nursing interventions for this group of patients.     

慢性阻塞性肺疾病患者生活质量影响因素分析

目的:分析影响慢性阻塞性肺疾病患者St.George’s呼吸疾病问卷和简明健康状况调查表评分的主要因素。方法:①选择2001-09/2002-03中山大学附属第一医院呼吸内科住院及门诊确诊的慢性阻塞性肺疾病患者75例。②采用St.George’s呼吸疾病问卷[包括3个维度,分别测评症状的频率和呼吸困难发作的时限和频率(呼吸症状),呼吸困难导致的活动受限(活动受限),以及疾病的影响(疾病影响)3个维度。各维度预计分值0～100,分数越低代表生活质量水平越高]和简明健康状况调查表(共36项问题,涉及生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能以及精神健康8个维度。各维度预计分值0～100,分数越高代表生活质量水平越高)评估慢性阻塞性肺疾病患者的生活质量。③根据对慢性阻塞性肺疾病患者的人口学特征调查以及临床检查的结果,引入以下13个可能的影响因素:第1秒用力呼气量占预计值的百分比、病程、吸烟指数、吸烟情况、过去1年用于呼吸系统的医疗费用、医疗照顾、体质量指数[体质量/身高2(kg/m2)]、性别、年龄、婚姻、职业、教育程度、月收入等。④对资料进行相应的统计分析,应用逐步多元回归分析筛选出主要影响因素。结果:慢性阻塞性肺疾病患者75例所填问卷均准确、完整,全部进入结果分析。①病程对St.George’s呼吸疾病问卷和简明健康状况调查表的生活质量量表的2个总分及9个维度中的6个维度有影响(标准回归系数β为0.232～0.370,t=2.336～3.937,P<0.05～0.01)。②第1秒用力呼气量占预计值的百分比对St.George’s呼吸疾病问卷的总分和3个维度有影响(标准回归系数β分别为-0.501,-0.259,-0.451,-0.133,t=-4.913,-2.208,-4.676,-3.982,P<0.01),对简明健康状况调查表中的生理机能亦有影响(标准回归系数β为0.360,t=-3.684,P=0.000)。③性别影响St.George’s呼吸疾病问卷的总分和呼吸症状与疾病影响维度(标准回归系数β为-0.249,-0.501,-0.319,t=-2.426,-3.371,-2.935,P<0.05～0.01)。④医疗费用对简明健康状况调查表总分和St.George’s呼吸疾病问卷的活动受限有影响(标准回归系数β为-0.355,0.199,t=-3.092,2.105,P<0.01,0.05)。⑤职业对St.George’s呼吸疾病问卷的活动受限和简明健康状况调查表的情感职能有影响(标准回归系数β为-0.196,0.252,t=-2.047,2.212,P<0.05)。⑥吸烟情况对St.George’s呼吸疾病问卷的呼吸症状,教育程度对简明健康状况调查表的总分,月收入对简明健康状况调查表的精力,体质量指数对简明健康状况调查表的一般健康状况均有影响(标准回归系数β为0.414,-0.233,0.226,0.268,t=2.517,-2.011,2.042,2.364,P<0.05)。结论:影响慢性阻塞性肺疾病患者生活质量的主要因素有病程、第1秒用力呼气量占预计值的百分比、性别、过去1年用于呼吸系统的医疗费用、职业等。     

慢性阻塞性肺疾病患者社会支持与生活质量的研究

目的探讨慢性阻塞性肺疾病(COPD)缓解期患者社会支持与生活质量。方法对40例老年(>60岁)COPD缓解期患者和40例正常老年对照组患者分别进行社会支持评定量表(SSRS)、日常生活能力量表(ADL)的调查和评定。结果COPD组的社会支持总分显著低于对照组(P<0.01);日常生活总分均值29.55,显著高于对照组(P<0.01),表明有明显功能障碍。结论COPD患者社会支持度较低,日常生活能力较差;对COPD患者进行康复治疗,减少反复发作是提高生活质量的重要措施之一。     

慢性阻塞性肺疾病患者生活质量与自我效能相关性研究

目的:探讨慢性阻塞性肺疾病(COPD)患者生活质量与自我效能的相关性。方法:于2011年4-11月采用便利抽样的方法,选取广州市某医院病情稳定、准许出院的患者和门诊患者进行调查,分别使用圣乔治呼吸问卷和COPD自我效能量表对患者的生活质量和自我效能进行测评。结果:COPD患者生活质量的症状评分与自我效能的负面影响、极端的情绪激动、体力活动、天气/环境维度评分均具有相关性(r=0.28～0.33,P<0.05)。COPD患者生活质量的活动评分、影响评分及总分评分与患者自我效能的各维度评分均具有相关性(r=0.38～0.58,P<0.01)。结论:COPD患者的生活质量与自我效能存在关联,患者的自我效能水平越高,其生活质量也越高,提示可以从提高患者的自我效能水平着手,改善COPD患者的生活质量。     

慢性阻塞性肺疾病患者生存质量的研究进展

阐述影响慢性阻塞性肺疾病 (COPD)患者生存质量 (QOL)的因素,慢阻肺康复治疗对提高生存质量的作用以及生存质量研究在慢阻肺中应用的进展,并展望生存质量研究的前景。     

Assessing quality of life of patients with advanced chronic obstructive pulmonary disease in the end of life

Given the limitations of existing health-related quality-of-life (QOL) measures in capturing the end-of-life experience of patients with advanced chronic diseases, an empirically grounded instrument, the quality-of-life concerns in the end of life questionnaire (QOLC-E), was developed. Though it was built on the McGill quality of life questionnaire (MQOL), its sphere is more holistic and culturally specific for the Chinese patients in Hong Kong. One hundred and forty-nine patients with advanced chronic obstructive pulmonary disease (COPD) or metastatic cancer completed the questionnaire. Seven factors (28 items) which emerged from the factor analysis were grouped into four positive (support, value of life, food-related concerns, and healthcare concerns) and four negative (physical discomfort, negative emotions, sense of alienation, and existential distress) subscales. Good internal consistency and concurrent validity were shown. The results also revealed that these two groups of patients had similar QOL concerns. The validity of applying QOLC-E as an outcome measure to evaluate the effectiveness of palliative and psychoexistential interventions has yet to be tested.     

个案管理对慢性阻塞性肺疾病患者生活质量的影响

目的探讨个案管理对慢性阻塞性肺疾病患者生活质量的影响。方法将符合纳入标准的103例慢性阻塞性肺疾病患者分为观察组（51例）和对照组（52例）,自患者入院至出院后3个月内,对照组接受常规护理和随访,观察组在此基础上实施个案管理,首先培训个案管理护士,设计个案管理记录表,与患者一起制订呼吸功能锻炼、康复运动计划,患者出院后通过电话和门诊相结合的方式进行随访实施个案管理。结果干预后两组患者生活质量均提高,其中出院后1个月、3个月观察组患者生活质量高于对照组,差异具有统计学意义（P〈0．01）。结论个案管理能够提高慢性阻塞性肺疾病患者的生活质量。     

优质护理对慢性阻塞性肺病患者心理和生活质量的影响

目的:观察优质护理对慢性阻塞性肺病(COPD)患者焦虑、抑郁症状和生活质量的影响.方法:将124例COPD患者随机分为观察组和对照组各62例,观察组采用优质护理,对照组采用常规护理.比较观察两组护理后焦虑、抑郁状况及生活质量.结果:观察组护理后不论是SAS、SDS评分还是躯体功能、角色功能、情绪功能、社会功能和总体生活质量评分,均较对照组明显改善(P＜0.05).结论:对COPD患者采用优质护理能够明显改善患者的焦虑、抑郁症状,提高生活质量.     

Effects of self-management education on quality of life of patients with chronic obstructive pulmonary disease

PurposeTo explore the effects of self-management education on the quality of life of patients living with chronic obstructive pulmonary disease (COPD).MethodsEighty-four stable or discharged COPD subjects were recruited from April 2011 to January 2012 following treatment at Beijing Hospital or Peking Union Medical College Hospital. Subjects were divided into an intervention group who underwent self-management education or a control group who received usual care without additional education (n = 42 each). The St George's Respiratory Questionnaire (SGRQ) was used to measure quality of life at three and six months.ResultsSGRQ impact domain scores revealed significant differences between the groups (t = −2.167, p < 0.05) at three months. SGRQ symptom, impact, activity domain and total scores revealed significant differences between groups (t = −3.482 to −2.530, p < 0.05) at six months.ConclusionA nurse-led, simple, structured self-management education program provided an effective method for the management of patients with COPD.     

Health-related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome)

The association of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD) is not rare as COPD and OSA are both frequent diseases. The aim of this study was to determine the effect of OSA on quality of life (QOL) in patients with overlap syndrome (OVS). Thirty subjects with OVS and 15 control subjects participated. The St George's Respiratory Questionnaire (SGRQ) was used to determine QOL. The control group included subjects with COPD and no evidence of OSA by overnight polysomnography. All subjects were habitual snorers with normal Epworth Sleepiness Scale scores. Significant differences were found between the groups for the total score and each of the three components of the SGRQ suggesting worse QOL in OVS patients (symptoms 54.9 +/- 18.9 vs. 38.2 +/- 19.3, p = 0.008; activity 59.2 +/- 16.2 vs. 44.4 +/- 11.3, p = 0.003; impacts 35.2 +/- 23 vs. 20.8 +/- 8.7, p = 0.025 and total 45.7 +/- 17.7 vs. 30.9 +/- 8.7, p = 0.004 in OVS patients and control group, respectively). Obstructive sleep apnoea has a major impact on QOL in patients with OVS and can exist in COPD patients with habitual snoring even in the absence of daytime sleepiness. Further studies are needed to determine the impact of OSA treatment on QOL and morbidity in this population.     

Measurement of pulmonary artery to aorta ratio in computed tomography is correlated with pulmonary artery pressure in critically ill chronic obstructive pulmonary disease patients

AimChronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases and a common cause of death. Identification of COPD patients at high risk for complications and mortality is of utmost importance. Computed tomography (CT) can be used to measure the ratio of the diameter of the pulmonary artery (PA) to the diameter of the aorta (A), and PA/A ratio was shown to be correlated with PA pressure (PAP). However, the prognostic value of PA size remains unclear in patients with COPD. We hypothesized that PA enlargement, as shown by a PA/A ratio greater than 1, could be associated with a higher risk of mortality in COPD patients admitted to the intensive care unit.MethodsData of patients admitted to a medical intensive care unit of a university hospital were retrospectively reviewed between January 2008 and December 2012. Patients who were identified to have a diagnosis of acute exacerbation of COPD and who had an echocardiogram and CT scan were included. Pulmonary artery to aorta ratio was calculated and patients were grouped as PA/A ≤ 1 and PA/A > 1. Comparisons were made between the groups and between patients who died and survived. Correlation analysis, survival analysis, and logistic regression analysis were done, where appropriate.ResultsOne hundred six COPD patients were enrolled. There were 40 (37.4%) patients who had a PA/A > 1. Echocardiography measured PAP was higher in the group with PA/A > 1 than in those with PA/A ≤ 1 (62.1 ± 23.2 mm Hg vs 45.3 ± 17.9 mm Hg, P = .002). Mortality rate of patients with PA/A > 1 was higher (50%) than of those patients with PA/A ≤ 1 (36.4%), although the difference did not reach a statistical significance (P = .17). Correlation was found between vmeasured PA diameter and PAP (r = 0.51, P = .001) as well as between the Acute Physiology and Chronic Health Evaluation II values and PAP (r = 0.25, P = .025).ConclusionThe PA/A ratio is an easily measured method that can be performed on thorax CT scans. Although, we failed to demonstrate a statistically significant association between higher PA/A and increased mortality, PA/A can be used as a surrogate marker to predict the pulmonary hypertension.     

护理干预对慢性阻塞性肺病患者生活质量及睡眠的影响

目的 探讨护理干预对慢性阻塞性肺病患者生活质量及睡眠的影响,观察其临床意义,以期为临床工作提供理论帮助.方法 收集慢性阻塞性肺病患者共158例,依随机的原则分为观察组与对照组各79例,对照组应用常规护理,观察组在常规护理基础上加用特定的护理干预,应用生活质量量表评价患者的生活质量的差别,应用睡眠质量量表评价患者的睡眠状况.同时选取100例健康成人作为正常对照.结果 与健康成人比较,患者生活质量明显降低,睡眠质量差,观察组在干预后生活质量明显高于对照组,观察组患者的睡眠质量明显优于对照组.结论 慢性阻塞性肺病患者生活质量和睡眠质量明显下降,而应用特定的护理干预,能有效改善患者的生活质量,提高睡眠质量,临床治疗中可以积极应用,以提高患者的整体恢复.     

慢性阻塞性肺疾病患者的睡眠质量调查

目的:进行慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)患者睡眠质量的调查,研究其规律性。方法:研究对象为2000-08/2003-08在本院门诊就诊和住院治疗的55例COPD患者。病例纳入标准:①符合1997年中华医学会制定的COPD诊疗规范中有关COPD稳定期诊断标准。②自愿接受各种量表调查。排除患有其他严重的躯体性疾病;有精神疾病或精神疾病家族史;有严重智力或认知障碍患者。分别接受了睡眠质量调查和血气检查,并与对照组同期结果进行比较。结果:在睡眠质量比较中,COPD组的入睡(1.18±0.29)、睡眠维持(0.41±0.05)、睡眠自评(0.79±0.11)、午休时间(1.35±0.20)、睡眠总时间(1.02±0.24)、梦记忆情况(1.16±0.14)等因子评分和睡眠质量总分(5.16±0.88)均明显高于对照组(t=2.201～3.137,P<0.01～0.05)。COPD患者按血氧分压水平分组后,血氧分压水平明显偏低组(21例)的入睡、睡眠维持、睡眠自评、睡眠总时间、梦记忆情况等因子评分和睡眠质量总分均明显高于血氧分压水平偏低组(34例)(t=2.092～3.108,P<0.01～0.05)。结论:COPD患者有明显的睡眠质量下降,与血氧分压水平有一定联系。     

慢性阻塞性肺疾病患者社会支持状况及对生命质量的影响

目的：调查慢性阻塞性肺疾病（ＣＯＰＤ）患者社会支持状况,并分析社会支持对其生命质量的影响。方法：６０例ＣＯＰＤ患者和６０例健康者应用个人资源询问表进行社会支持评分,同时对ＣＯＰＤ患者应用ＣＯＰＤ的生命质量问卷作评估。结果：ＣＯＰＤ患者的社会支持评分低于健康对照组（Ｐ＜０．０５）。年龄、病程和通气功能与ＣＯＰＤ患者的社会支持评分呈显著相关（Ｐ＜０．０５）;社会支持评分与ＣＯＰＤ患者的生命质量中生活能力、社会和抑郁症状评分相关性有统计学意义（Ｐ＜０．０５）。结论：加强社会支持有可能提高ＣＯＰＤ患者的生命质量。     

呼吸训练和沙美特罗替卡松干粉剂治疗对慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的:观察呼吸训练对慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)患者的肺功能和生活质量的影响,寻求提高康复效果的有效途径。方法:本实验于2002-06/2003-12在湛江中心人民医院呼吸内科完成。同期本院呼吸内科门诊COPD患者160例。符合标准患者70例,最终纳入分析60例,采用随机数字法将患者分为治疗组和对照组,各30例。治疗组每天进行2次呼吸操训练并吸入沙美特罗替卡松干粉剂2次,对照组应用常规呼吸内科对症治疗和一般的肢体活动。治疗前及治疗24周后检查两组患者肺功能,并进行生活质量评估。结果:治疗前两组肺功能、生活质量评分差异无显著性意义(P>0.05)。治疗组治疗后肺功能较治疗前及对照组治疗后明显改善(P<0.05～0.01)。治疗组治疗后生活质量评分(日常生活能力:2.03±0.56,社会活动能力:2.18±0.51,抑郁:2.04±0.48,焦虑:1.92±0.51,生活质量总均分:2.04±0.52)较治疗前(2.58±0.62,2.74±0.54,2.57±0.68,2.42±0.56,2.58±0.60)及对照组治疗后(2.55±0.61,2.72±0.62,2.56±0.68,2.45±0.43,2.57±0.59)明显改善(P<0.01)。结论:呼吸训练和沙美特罗替卡松干粉剂治疗能够明显改善COPD患者的肺功能和提高生活质量。     

健康指导对稳定期慢性阻塞性肺疾病病人生活质量的影响

[目的]探讨健康指导对稳定期慢性阻塞性肺疾病(COPD)病人生活质量的影响。[方法]对36例稳定期COPD病人开展教育指导,教育并督促其进行呼吸肌锻炼、长期家庭氧疗、戒烟、营养支持、用药指导等,确保病人及家属掌握疾病相关知识,确保护理措施得以实施。[结果]干预后病人生活质量显著提高(均P<0.05)。[结论]健康指导可有效提高稳定期COPD病人的生活质量。     

规范家庭护理对慢性阻塞性肺疾病病人生活质量的影响

慢性阻塞性肺疾病(COPD)是内科呼吸系统的常见病、多发病[1],包括慢性支气管炎、肺气肿、肺心病,是一种迁延不愈、反复发作、进行性发展的疾病,给病人带来极大压力和痛苦.