Interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease patients

目的 评价不同管理模式对慢性阻塞性肺疾病(COPD)患者的干预效果.方法 根据患者门诊定期随访和参加教育活动情况,将COPD患者分为系统教育组(能定期随访并接受系统教育)、单纯随访组(能定期随访但未参加系统教育)和对照组(未能定期随访也未参加系统教育).对2002年5月至2010年5月在北京大学人民医院呼吸科COPD门诊建立档案并配合随访的157例COPD患者进行面对面调查,内容包括患者的一般情况,调查前1年急性加重情况、COPD评估测试(CAT)问卷评分、改良的英国医学研究委员会呼吸困难量表(mMRC)评分、肺功能测定 ;完成COPD患者的临床分型.结果 系统教育组和随访组前1年急性加重次数分别为(0.9±1.1)次和(1.0±0.8)次,明显少于对照组的(1.4±1.1)次,差异均有统计学意义(均P ＜0.05).系统教育组和单纯随访组前1年急性加重≤1次的比例分别为71.2％和68.6％,明显高于对照组的44.4％,差异均有统计学意义(均P＜0.01).系统教育组和单纯随访组CAT分值(10.0±5.0和11.1±6.0)低于对照组(15.3±6.8),差异均有统计学意义(均P＜0.01).系统教育组和单纯随访组CAT分值≤20分比例(96.2％和88.2％)均高于对照组(64.8％),差异均有统计学意义(均P＜0.01).系统教育组和单纯随访组mMRC评分(1.5±0.8和1.6±0.9)均低于对照组(2.1±1.0),差异均有统计学意义(均P＜0.05).临床评估分型显示三组间A型、B型比例差异无统计学意义(P＞0.05).系统教育组C型(15.4％)高于对照组(1.9％),差异有统计学意义(P＜0.05),系统教育组和单纯随访组D型(38.5％和35.3％)低于对照组(66.7％),差异均有统计学意义(均P＜0.01).结论 长期系统教育和随访管理模式可以有效地减少COPD患者的急性加重,改善其生活质量.Objective To evaluate the interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease (COPD) patients.Methods Systemic education,follow-up and control groups were divided according to the frequency of follow-ups and the profile of participating in educations.A total of 157 patients were enrolled into the COPD database from May 2002 to May 2010.They were interviewed face-to-face at our department.The investigation contained general conditions,the frequency of acute exacerbations (AE) the previous year,COPD Assessment Test (CAT),Modified British Medical Research Council Dyspnea Scale (mMRC) and spirometric classification.A combined assessment was conducted.Results The frequency of AE and rate of AE ＜ once the previous year in systemic education group was 0.9 ± 1.1 and 71.2％,1.0 ± 0.8 and 68.6％ in follow-up group and 1.4 ± 1.1 and 44.4％ in control group.And the frequency of AE in systemic education and follow-up groups was significantly less than that in control group (P ＜ 0.05).Rate of AE ＜ once in systemic education and follow-up groups was significantly higher than that in control group (P ＜0.01).CAT and rate of CAT≤20 in systemic education,follow-up and control groups were 10.0 ±5.0 and 96.2％,11.1 ±6.0 and 88.2％,15.3 ± 6.8 and 64.8％ respectively.CAT in systemic education and follow-up groups was significantly lower than that in control group (P ＜0.01).Rate of CAT≤20 in systemic education and follow-up groups was significantly higher than that in control group (P ＜ 0.01).mMRC in systemic education,follow-up and control groups was 1.5 ± 0.8,1.6 ± 0.9 and 2.1 ± 1.0 respectively.mMRC in systemic education and follow-up groups was significantly lower than that in control group (P ＜ 0.05).Combined assessment showed that no significant difference existed in Types A and B among three groups (P ＞ 0.05).Type C in the systemic education group was significantly higher than that of the control (P ＜ 0.05).Type D in the systemic education and follow-up groups was significantly lower than that of the control (P ＜ 0.01).Conclusion Long-term systemic education and follow-up management program can reduce the frequency of AE of COPD effectively and improve the health status of COPD patients.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0443117-31219