1992～1999年慢性阻塞性肺疾病、肺心病社区人群综合干预结果

目的 评价社区综合干预防治慢性阻塞性肺疾病（COPD）和肺心病效果。方法 1992年进行基线调查,并开始对干预人群进行社区综合干预试验,2000年5月对所有基线人群进行入户调查,基线高危人群随机抽取50％,COPD和肺心病患者100％进行复查。结果 应查3739名,应答3316名,应答率为88．7％,应答者数据完整率为92．7％。随机抽查814名,干预区接受到吸烟有害健康的宣传率、接受到预防COPD知识的宣传率、定期受到医生主动治疗和咨询率均显著高于对照区（P＜0．01）。干预区戒烟率为28．2％,对照区为23％（P＝0．004）。干预区一秒钟用力呼气容积（FEV1）和最大肺活量（FVC）降低速度均显著低于对照区（P＜0．05）。干预区与对照区COPD患病率分别比基线增加5．6％和8．0％（P＝0．03）;干预区与对照区肺心病患病率分别比基线增加3．5％和6．7％（P＝0．02）。1995－1999年干预区、对照区肺心病年均死亡率分别为72／10万和95／10万（P＝0．0044）。结论 干预区人群干预措施到位率高于对照区,提高了戒烟率,延缓了肺功能下降速度,减少了COPD和肺心病患病率的增幅及肺心病死亡率,提示社区综合干预是一种有效延缓COPD发生和肺心病死亡的措施。

Results of community intervention trial for chronic obstructive pulmonary diseases and chronic cor-

Objective To evaluate the effect of community intervention for COPD and chronic cor pulmonale Methods The baseline survey of the study was carried out in 1992 The total population was randomly divided into intervention and control regions From 1992 the comprehensive community intervention trial was conducted in the intervention region The data of baseline study has been published elsewhere The family inquiry was made in all baseline population,50 percent of high risk population and 100 percent of COPD and cor pulmonale population were reexamined Results Of the 3 739 subjects who should be investigated 3 316 subjects were really investigated (88 7% of responsive rate) Of 814 subjects randomly abstracted from 3 316 in intervention and control regions, the awareness rates of smoking harm to health were 95 0% and 80 0%, of how to prevent and treat COPD were 62 0% and 35 7%, of regular visit by doctors were 46 1% and 27 0% respectively The rate of ex smoker was 28 2% in intervention region more than that of 23% in control region ( P =0 004) Of 3 075 subjects undergone lung function test, FEV 1 decrements per capita yearly were 32 0 ml and 37 9 ml ( P =0 001);FVC decrement were 42 0 ml and 48 3 ml ( P =0 012) in intervention and control regions The prevalence increment in COPD were 5 6% and 8 0% ( P =0 03), cor pulmonale were 3 5% and 6 7% ( P =0 02) compared to baseline survey in both regions The mortality of cor pulmonale were 72 9 and 95 per 100 000 per year ( P =0 0044) from 1995 to 1999 Conclusion The rate of quiting smoke is significantly increased by intervention The declination of lung function significantly decreases The increment in prevalence of COPD and cor pulmonale significantly decreases The mortality of cor pulmonale decreases significantly in intervention region The results indicates that the comprehensive intervention in community is an important measurement for decreasing incidence of COPD and mortality of cor pulmonale