不同时期 COPD 患者肺康复时间依从性的比较及影响因素分析

目的 探讨慢性阻塞性肺疾病（COPD）患者不同时期进行肺康复治疗的时间依从性差异及其影响因素。方法 连续选取 2013 年 6 月—2015 年 5 月天津市胸科医院呼吸与危重症科因 COPD 急性加重住院患者， 最终到达观察终点 304 例， 随机分为稳定期康复组（178 例）及急性加重期康复组（126 例）； 根据所有患者实际完成康复时间是否大于计划康复时间的 70%判定依从性， 并据此分为依从性好组（115 例）及依从性差组（189 例）。 分别比较稳定期康复组及急性加重期康复组实际完成康复时间、达到依从性好的患者比例及退出率， 比较依从性好组及依从性差组的一般临床资料， 在肺康复结束后， 采用 Logistic 回归分析影响肺康复依从性的因素。 结果 稳定期康复组实际完成康复时间、达到依从性好的患者比例均高于急性加重期康复组（ [ 5 641.5±1 080.1）min vs.（4 426.5±1 046.8）min， 46.7% vs. 25.4%）]， 稳定期康复组退出率 10.6%（21/199）低于急性加重期康复组的退出率 26.7%（46/172）； 依从性好的患者家庭月收入水平、6 分钟内步行距离（6MWD）高于依从性差组， 年龄、吸烟者比例、呼吸困难评分（MRC 评分）及 COPD 评估测量（CAT）评分低于依从性差组（均 P < 0.05）。 Logistic 回归分析结果显示年龄大、吸烟、MRC 评分高、CAT 评分高是肺康复依从性差的危险因素， 月收入≥3 000 元、6MWD 长是保护因素。 结论 COPD 患者整体肺康复时间依从性较差， 年龄低、不吸烟、收入水平高、生活质量及健康状况好的患者肺康复时间依从性佳。

Comparison and analysis of the adherence of pulmonary rehabilitation in patients in different periods of chronic obstructive pulmonary disease

Objective To explore the differences and infection factors of adherence of pulmonary rehabilitation(PR) in different periods of chronic obstructive pulmonary disease(COPD) patients. Methods The 304 patients were randomly distributed into two groups,including stable COPD with PR group(n=178) which perform PR after exacerbation and remain stable for 12 weeks,and AECOPD with PR group(n=126) which perform PR instantly after acute phrase.The course of PR is 12 weeks According to the adherence definition(practical time of accompolish PR programm > 70% of that planned time),we divided into good time-adherence group(n=115) and bad time-adherence group(n=189).Comparison of practical-perform time of PR, proportion of good time-adherence and PR quitting between two groups.Basic data of patients were collected and analyzed and independ infection factors of adherence was analyszed through binary logistic regression.Results The practical-perform time of PR, proportion of good time-adherence in stable COPD with PR group were higher than AECOPD with PR group while the PR quitting proportion was lower than AECOPD with PR group.Compare with AECOPD PR group,the income level and 6MWD were hingher in stable COPD PR group;and the age,proportion of tabacco-exposed,MRC scores and CAT scores were lower in Stable COPD group.Older-age, tabacco-exposed, higher MRC and CAT scores are danger factors for PR adherence, while the higher income level and longer 6MWD are protective factor for PR time-adherence in patients with COPD(P<0.05）. Conclusion The time adherence of COPD patients who undergo pulmonary rehabilitation was disappointing,especially postexacerbation.Good adherence would be expected in younger age, non tabacco-exposed, higher income level and better health-related quality of life.