太原市老年干部慢性阻塞性肺疾病稳定期社区管理疗效评价

目的评价社区管理干预措施对老年干部慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）稳定期的疗效。 方法采取整群随机抽样的方法在太原市老年干部相对集中居住的12个社区选取252例65岁以上的老年干部COPD稳定期患者，以随机数字表法将其分为管理组和对照组。管理组给予包括健康宣教、规范药物治疗、肺康复训练在内的综合干预措施，患者定期复诊或医生主动随访；对照组给予规范的药物治疗，且定期随访。两组患者均随访1年。分别于管理前后测定并比较两组患者的肺功能一秒用力呼气容积（forced expiratory volume in one second, FEV₁）占用力肺活量（forced vital capacity, FVC）比值（FEV₁/FVC），FEV₁占预计值的百分比（FEV₁%pred）]、改良呼吸困难指数（modified medical british research council, mMRC）、COPD评估测试（COPD assessment test, CAT）、急性加重次数、简易营养评价量表（mini nutritional assessment short-form, MNA-SF）以及6 min步行距离（6-min walk distance, 6MWD）。正态分布计量资料的组间比较采用t检验，非正态分布计量资料的组间比较采用秩和检验；计数资料的组间比较采用χ²检验。 结果管理组患者治疗管理后的FEV₁%pred、mMRC及CAT均显著降低，6MWD及MNA-SF均显著升高，差异均有统计学意义（t=3.584、12.151、17.156、-21.911、-10.500，均P<0.01）；对照组患者治疗管理后的FEV₁/FVC、FEV₁%pred及6MWD均显著降低，mMRC及CAT组显著升高，差异均有统计学意义（t=14.145、5.038、5.653、-5.777、-9.749，均P<0.01）。管理组患者治疗管理前FEV₁/FVC、CAT及6MWD均优于对照组患者（t=4.574、-4.758、4.026，均P<0.01），治疗管理后mMRC、MNA-SF、FEV₁/FVC、CAT及6MWD均优于对照组患者（t=-12.267、6.675、10.599、-10.166、21.811，均P<0.01）。两组患者各观察指标治疗管理前后的差值比较结果显示，FEV₁/FVC、mMRC、CAT、6MWD、MNA-SF差值的差异均有统计学意义（z=-7.037、-1.886、-9.798、-11.887、-8.442，t=7.463，均P<0.01）。管理组管理治疗期间急性加重次数≥2次/年者显著少于对照组，差异有统计学意义（χ²=19.33，P<0.01）。 结论对COPD稳定期患者进行包括健康宣教、规范药物治疗、肺康复训练等在内的综合管理，能够有力改善呼吸困难症状、运动耐力及营养状态，并能降低急性加重风险，明显提高患者生活质量。

Curative effect evaluation of community health management to Taiyuan elderly health cadres with stable chronic obstructive pulmonary disease

ObjectiveThe research aims to evaluate the curative effects of community health management interventions on stable chronic obstructive pulmonary disease (COPD). MethodsThe research is based on the information of 252 COPD patients who are over the age of 65. They were randomly selected from 12 communities of Taiyuan city. With the assessment of their baseline information, the patients were randomly assigned to the experimental group and the control group. A set of comprehensive intervention measures were applied to the patients of experimental group, such as health education, specification of drug therapy and pulmonary rehabilitation training. In addition, the patients were advised to see their doctors regularly or the doctors followed up their patients actively. While there was only specification of drug therapy for the control group. Patients were followed up for 1 year. The patients of two groups were given the tests before and after the management as follows: FEV₁/FVC, FEV₁/pred, mMRC, CAT, Acute exacerbation frequency, 6MWD and SF-MNA. And the results were compared within and between groups by student t test for normal distributed data, non-parametric analysis for abnormal distributed data, Chi-square test for categorical data. ResultsThere was a significant difference in FEV₁%pred, mMRC, CAT, 6MWD and MNA-SF in experimental group after treatment (t=3.584, 12.151, 17.156, -21.911, -10.500, and P < 0.01); There was a significant difference within the statistics of the control group before and after the intervention in FEV₁/FVC, FEV₁%pred, mMRC, CAT, 6MWD (t=4.145, 5.038, 5.653, -5.777, -9.749, and P < 0.01). There was a significant difference in FEV₁/FVC, CAT, 6MWD between the two groups before the intervention (t=4.754, -4.758, 4.026, and P < 0.05); and a significant difference in mMRC, MNA-SF, FEV₁/FVC, CAT, 6MWD between the two groups after the intervention (t=-12.267, 6.675, 10.599, -10.166, 21.811, and P < 0.01). There was a significant difference in the constituent ratio of acute exacerbation frequency. The frequency of the experimental group was less than the control group (χ²=19.33, P < 0.01). ConclusionIt is possible to improve the symptoms of dyspnea, enhance the quality of life, boost the exercise tolerance, improve the nutrition state and decrease the risk of worsening through community management intervention in the elderly with COPD.