慢性阻塞性肺疾病患者社区管理一年效果评价  

Effectiveness of one-year community management for patients with chronic obstructive pulmonary disease

作　　者：李凡[1] 徐迅[1] 张学民[1] 蔡映云[2] 朱王汇[1] 傅欢英 沈朝英 陆元英 庄棋军 殷建峰 李苏华[1] 殷为文[1] 周关华[1] 陈小丽[1] 

机构地区：[1]上海交通大学附属第一人民医院松江分院,201600 [2]复旦大学附属中山医院呼吸病研究所 [3]上海市小昆山社区卫生服务中心 [4]上海市新浜社区卫生服务中心

出　　处：《中华全科医师杂志》2011年第3期171-174,共4页Chinese Journal of General Practitioners

基　　金：基金项目：上海市卫生局课题（2007169）;上海市松江区科委基金支持项目（2007医学）

摘　　要：目的 评价社区卫生服务中心管理慢性阻塞性肺疾病（COPD）患者的效果.方法 采用准实验设计方法,以上海市松江区小昆山和新浜两乡镇社区卫生服务中心服务区域内2008年登记的COPD患者为研究对象.小昆山社区作为COPD管理组,管理内容包括：对社区全科医生做COPD防治知识培训,社区卫生服务中心基本防治药物配置,COPD患者及家属的COPD防治基本知识教育.新浜社区为对照组.结果 两社区肺功能检查诊断出COPD 132例,小昆山61例,新浜71例.完成1年随访后资料完整的小昆山47例,新浜55例.小昆山初访时吸烟者5例,1年后成功戒烟3例;新浜初访时吸烟者19例,研究结束时无戒烟者.比较两个社区COPD患者1年中症状、生存质量、肺功能、呼吸困难评分及6 min步行距离,第1秒用力呼气容积FEV1和症状的评估差值的差异无统计学意义,生存质量方面小昆山患者从初访时的46.96下降到1年后的39.12,降低-7.84;新浜患者从56.55上升到62.11,上升5.56;小昆山6 min步行距离从初访时的361.66下降到1年后的354.26,而新浜从398.07下降到351.18;小昆山功能性呼吸困难评估从初次0.40下降到0.34,而新浜从0.95上升到1.00;1年里,小昆山和新浜患者急诊分别为13例次和53例次,住院分别为4例次和5例次,新浜有4例因COPD急性加重死亡,小昆山则无.结论 提高社区全科医生、患者和家属的COPD防治能力和防治水平,可以改善患者的生存质量,减少急性发作和住院次数,减轻呼吸困难程度和延缓6 min步行距离的下降.Objective To evaluate effectiveness of prevention and treatment for patients with chronic obstructive pulmonary disease （COPD） for one year at community health-care service （CHS）centers. Methods A quasi-experiment design was used to evaluate effectiveness of community management for patients with COPD who visited and registered at Xiaokunshan and Xinbang CHS centers in Songjiang district of Shanghai in 2008, with COPD patients from Xiaokunshan community CHS center as management group and those from Xinbang as control. Measures for community management included training for local general practitioners in essential knowledge of COPD prevention and treatment, allocation of necessary drugs for COPD treatment, and health education for COPD patients and their family members. No special measures were taken for control group except routine treatment. Results A total of 132 patients were diagnosed as COPD according to their pulmonary function on 2008, 61 at Xiaokunshan and 71 at Xinbang CHS canters.One hundred and two patients, 47 at Xiaokunshan and 55 at Xinbang, finished one-year follow-up. Five patients from Xiaokunshan who were smokers at their first visits and three of them quitted smoking after oneyear management. Meanwhile, none of nine smoked patients from Xinbang quitted smoking in the same period. There was no statistically significant difference in symptom scores, pulmonary function, and forced expiratory volume at the first second （FEV1） between patients in the two groups during one-year follow-up.Average score of quality of life in patients at Xiaokunshan dropped to 39. 12 after one-year management from 46. 96 at their first visits, and that in patients at Xinbang increased to 62. 11 from 56. 55 （P〈0.01）.Average six-minute walking distance （6-MWD） in patients at Xiaokunshan reduced to 354. 26 meters after one-year management from 361.66 meters at their first visits, meanwhile that in patients at Xinbang reduced to 351.18 meters from 398.07 meters （P =0. 008）. Scores of functional dys

关 键 词：肺疾病 慢性阻塞性 社区卫生中心 疾病管理 

分 类 号：R563.9[医药卫生—呼吸系统]