新型农村合作医疗对轻度慢性阻塞性肺疾病患者管理效果评价  

Effectiveness of new rural cooperative medical management for patients with chronic obstructive pulmonary disease in stage I

作　　者：张鲁阳[1] 邹德奇 张学顺[1] 徐艳丽[1] 高海[1] 赵建伟[1] 鲁宁[1] 

机构地区：[1]山东省海阳市第三人民医院呼吸内科,265100

出　　处：《中华全科医师杂志》2012年第6期430-433,共4页Chinese Journal of General Practitioners

基　　金：中华医学会临床医学慢性呼吸道疾病科研专项资金资助项目（07010010009）

摘　　要：目的评价新型农村合作医疗管理轻度慢性阻塞性肺疾病（COPD）患者的效果。方法2008年1月至2010年12月，采用准实验设计方法，以山东省海阳市东村和方圆两个办事处区域内的轻度COPD患者为研究对象。东村辖区COPD患者61例（管理组）接受3年新型农村合作医疗系统管理，管理内容包括戒烟宣传、脱离有害环境、使用流行性感冒疫苗、知识教育等。方圆辖区60例COPD患者作为对照组。结果管理3年后随访，管理组管理前与管理2年和3年后比较，BODE指数（字母所示依次为体重指数、气流阻塞、呼吸困难、运动能力）下降值均大于对照组同期（P〈0．01）；管理3年后患者年均感冒次数、急性加重次数、因COPD就诊次数明显低于自身管理前和对照组同期（P〈0．05）。在肺功能方面，两组管理前和3年后比较第一秒用力呼气容积、第一秒用力呼气容积／用力肺活量均有不同程度下降（P〈0．05），但二者变化不大（P〉0．05）。结论利用新型农村合作医疗体系对COPD患者进行管理，可以减少COPD的急性发作和就诊次数，提高生存质量。Objective To evaluate the effectiveness of management for patients with chronic obstructive pulmonary disease （ COPD ） in stage I at new rural cooperative medical facilities. Methods A quasi-experiment design was used for the evaluation of patients registering at Dongcun and Fangyuan sub- district offices in Haiyang. And 79 COPD cases from Dongcun sub-district offices were selected into the management group while 76 cases from Fangyuan the control group. The measures at the new rural cooperative medical facilities included smoking-free publicity, avoiding a hazardous environment, application of influenza vaccines and training of patients and local general practitioners in essences of COPD prevention and treatment. Except for routine treatment, no special measures were taken for the control group. Results Sixty-one patients in the management group and 60 in the control group completed a 3-year follow-up. Fifteen patients were smokers during their initial visits in the management group and 13 quitted smoking after a 3-year management. Meanwhile 19 patients were smokers during their initial visits in the control group and 3 of them quitted smoking within the same period. The decrement of BODE index between post-management at year 2＆3 and between pre-management was higher in the management group versus the control group within the same period（P 〈0. 01）. The annual average frequencies of eommon eold, acute attack and physician consultation were obviously lower post-management at year 3 than those pre-management and the control group within the same period （ P 〈 0. 05 ）. Lung functions of two groups deteriorated as compared with those 3 years before （ P 〈 0. 05 ）. But no statistical difference existed between two groups （ P 〉 0. 05 ）. Conclusion The management of COPD patients in stage I at new rural cooperative medical facilities can improve their quality of life and reduce their frequencies of common cold, aeute attaek and physician consultation.

关 键 词：肺疾病 慢性阻塞性 疾病管理 评价研究 新型农村合作医疗 

分 类 号：R563.9[医药卫生—呼吸系统]