老年综合评估在慢性阻塞性肺疾病治疗中的应用

目的探讨老年综合评估在慢性阻塞性肺疾病（chronic obstructive pulmo-nary disease, COPD）治疗中的临床应用效果。 方法选取2017年1月至2018年4月新疆维吾尔自治区人民医院收治的99例老年COPD患者，其中采用常规专科治疗48例（对照组），采用CGA干预治疗51例（观察组）。记录两组患者治疗前及出院后1个月的各项评估结果包括基本日常生活活动能力（basic activity of daily living, BADL）、工具性日常生活能力（instrumental activity of daily living, IADL）、步态、跌倒、认知功能、焦虑、抑郁]，以及治疗前及出院后3个月的COPD评估测试（COPD assessment test, CAT）结果，并随访出院后6个月内再次急性发作、再住院治疗、合并症、死亡、呼吸衰竭等不良事件的发生情况；以及一秒用力呼气容积占预计值的百分比（FEV1/FVC）及6 min步行试验（6MWT）等指标。 结果与治疗前比较，两组患者治疗后BADL、IADL评分并无明显变化（均P>0.05），步态、跌倒、认知功能、焦虑、抑郁的评分均明显改善（均P<0.05）。治疗前，两组患者BADL、IADL、步态、跌倒、认知功能、焦虑、抑郁评分的差异无统计学意义（P>0.05），出院1个月后观察组步态、跌倒、认知功能、焦虑、抑郁评分均较对照组明显改善（均P<0.05）。治疗前，两组患者CAT评分的差异无统计学意义（P>0.05）；治疗后，观察组患者症状、活动能力、社会影响、FEV1/FVC及6MWT的评分均较对照组明显改善（均P<0.05）。随访期间观察组患者再次急性发作、再住院治疗以及合并症的发生率明显低于对照组（均P<0.05）。 结论对于老年COPD患者，建议尽早应用综合评估技术，根据评估结果采取有效干预，可最大限度地维持和改善其功能状况和生活质量。

Clinical application of comprehensive geriatric assessment in chronic obstructive pulmonary disease

ObjectiveTo explore the clinical application of comprehensive geriatric assessment in the treatment of chronic obstructive pulmonary disease. Methods99 hospitalized elderly patients with chronic obstructive pulmonary disease (>60 years old) were randomly divided into routine treatment group (48 cases) and comprehensive assessment group (51 cases) in January 2017 to April 2018. We compare the general data of the subjects, the treatment effect of the two groups before and after the treatment, the slow lung assessment test, the 6 minute walk test, and the percentage of the one second forced expiratory volume. ResultsThere was no significant difference in general data between the two groups (P>0.05). There was no statistically significant difference between the two groups before and after treatment (P>0.05). The differences in gait, fall, cognitive function, anxiety and depression were statistically significant (P<0.05). The routine treatment group was compared with the CGA group at admission, and the BADL, IADL, gait, and fall of the patients were compared. There was no significant difference in the difference of cognitive function, anxiety and depression (P>0.05). After 1 month of discharge, the difference of BADL and IADL in the CGA group was not statistically significant (P>0.05), but the difference in gait, fall, cognitive function, anxiety and depression was statistically significant (P<0.05). The test showed that before treatment, there was no significant difference in the therapeutic effect between the 2 groups (P>0.05), and after 1 month of discharge, the symptoms, activity, social influence, FEV1/FVC and 6MWT control groups in group CGA were statistically significant (P<0.05), but there was no significant difference in sleep (P>0.05). After the treatment of the 2 groups, the differences of reacute attack, rehospitalization and complication were statistically significant (P<0.05), and there was no significant difference between death and respiratory failure (P>0.05). ConclusionThe comprehensive evaluation technique of old age has effect on the clinical treatment of chronic obstructive pulmonary disease. It is worth popularizing. It is suggested that the comprehensive evaluation technique should be applied as early as possible, and effective intervention should be taken to maintain and improve the functional status and quality of life of the elderly patients to the maximum.