社区慢性阻塞性肺疾病患者药物使用情况的调查研究  

Drug Use among Patients with Chronic Obstructive Pulmonary Disease in the Community

作　　者：沈菲[1] 韩一平[2] 吴学智[3] 凌小媛[4] 陈慎[1] 沈雁红 刘可可 施艇艇 杨建钊 任翠 李扬[9] 李长舜 刘岩[11] 徐爱静[2] 

机构地区：[1]上海市杨浦区殷行社区卫生服务中心,200438 [2]第二军医大学附属长海医院 [3]昆明医科大学公共卫生学院 [4]第二军医大学附属长征医院 [5]上海市浦东新区川沙新镇川沙社区卫生服务中心 [6]上海市宝山区高境镇社区卫生服务中心 [7]上海市闵行区马桥社区卫生服务中心 [8]上海市普陀区长征镇社区卫生服务中心 [9]上海市普陀区长风社区卫生服务中心 [10]上海市长宁区新泾镇社区卫生服务中心 [11]上海市普陀区白玉社区卫生服务中心

出　　处：《中国全科医学》2013年第13期1530-1532,共3页Chinese General Practice

摘　　要：目的了解上海市部分社区慢性阻塞性肺疾病(COPD)患者药物使用情况及与规范要求的差距,提高社区全科医师对COPD规范诊疗的意识。方法参考2011年COPD诊疗规范制定呼吸疾病问卷调查表,根据一般情况、临床表现或肺功能检查及相关治疗情况对上海市部分社区门诊患者进行问卷调查。结果共调查3 968例患者,行肺功能检查明确不完全可逆气流受限确诊为COPD的患者1 024例(占25.8%),男814例(占79.5%),女210例(占20.5%),吸烟者692例(占67.6%)。给予药物治疗者892例(占87.1%),其中β2-受体激动剂372例(占41.7%),抗胆碱能药物346例(占38.8%),糖皮质激素或混合制剂88例(占9.9%),其他药物86例(占9.6%);吸入给药150例(占16.8%),口服给药696例(占78.0%),静脉给药46例(占5.2%)。Ⅰ～Ⅳ级COPD患者药物治疗类型及用药途径差异均有统计学意义(P<0.05),Ⅰ级、Ⅱ级和Ⅲ级COPD患者中,以β2-受体激动剂、抗胆碱能药物口服治疗为主;Ⅳ级COPD患者中,以糖皮质激素或混合制剂吸入为主。结论目前社区COPD患者的药物治疗情况与诊疗规范要求存在一定差距,因此开展社区全科医师对COPD诊疗规范的学习并正确干预患者用药及制度化管理尤其重要。Objective To explore the current status of drug use among patients with chronic obstructive pulmonary dis- ease （COPD） in the community. Methods A respiratory disease questionnaire was made based on the 2011 COPD guideline. The outpatients of some communities in Shanghai were surveyed with the questionnaire on general information, clinical manifesta- tion, pulmonary function examination, and other relevant data. Results A total of 1 024 out of 3 968 patients were diagnosed as COPD based on incomplete airflow limitation from pulmonary function examination, including 814 males （79. 5% ） and 210 fe- males （20. 5% ）. Among them, 692 cases （67.6%） were smokers; 892 cases （87. 1% ） were treated with drugs, including 372 cases treated with β2 -agonists （41.7%）, 346 cases （38.8%） with anticholinergic drugs, 88 （9. 9% ） with glueocorti- coids or mixture preparation, 86 （9.6%） with other drugs. Administration routes included inhalation （ 150, 16. 8% ）, oral （696, 78. 0% ） and intravenous administration （46, 5.2% ）. Stage I - IV COPD patients differed significantly in types of medication and administration routes （ P 〈 0. 05 ）. Oral administration of β2 - agonists and anticholinergic drugs was common a- mong stageⅠ-Ⅲ COPD patients, while inhalation of glucocorticoids or mixture preparation was common among stage Ⅳ COPD patients. Conclusion There is still a gap between the drug use in clinical practice and the 2011 guideline in the treatment of COPD. Therefore, COPD guideline learning is essential for GPs to carry out effective interventions and management in the treat- ment of COPD.

关 键 词：肺疾病 慢性阻塞性 社区干预 药物治疗 全科医生 

分 类 号：R563[医药卫生—呼吸系统]