COPD患者诊疗现状调查及肺康复治疗对其疾病的影响

发布时间：2018-06-19 04:53

本文选题：COPD + 诊疗现状　；参考：《中南大学》2013年硕士论文

【摘要】：目的：通过对慢性阻塞性肺疾病患者进行问卷调查、定期随访、监测患者病情及肺功能动态变化、指导患者正确进行肺功能锻炼及督促患者行呼吸操锻炼等综合干预模式,研究了解慢性阻塞性肺疾病(COPD)患者目前诊疗现状,并与对照组比较以了解以肺功能锻炼为主的综合干预是否能减轻患者症状、提高患者生活质量、改善患者肺功能状况。方法：随机抽取2012年01月至2012年06月我院呼吸科就诊的COPD患者100名,对全部患者进行问卷调查及肺功能检查。将其中86名患者进行随机分组,分为对照组和干预组。指导干预组42名患者正确进行呼吸操锻炼并对干预组患者进行6个月的电话随访。6个月后再次对全部患者进行回访,并对其行问卷调查及肺功能检查。对所收集的数据整理,进行数据统计和分析。结果：100位COPD患者中男性病人86人,女性14人。平均年龄(65.98±8.81)岁。33人有职业粉尘烟雾暴露史。31人家族中有相关呼吸系统疾病。其平均吸烟指数为(43.21±34.85)包年。过去12个月中,100名患者急性加重次数中位数为1次,因急性加重产生的医疗费用的中位数为800元。疾病认识评分的平均得分为(4.15±2.24)分。患者的认识水平与其教育程度、收入水平呈正相关。体重指数(BMI)均值为(21.33±4.19)kg/m2。微型营养评价问卷(MNA)提示44人存在营养不良危险,有10名患者明确存在营养不良。抑郁自评量表(SDS)提示8人存在轻度抑郁,1人为重度抑郁。CAT平均得分为(19.22±7.22)。FEV1%预计值与BMI呈正相关,与SDS评分、CAT评分、mMRC评级、吸烟指数、急性发作次数呈负相关。6个月肺康复锻炼后,对照组和干预组之间的FEV1%预计值的差值(F=0.382, P=0.002)、mMRC评级(F=1.128.P=0.016)、CAT评分(F=1.127.P=0.012)均存在统计学差异。结论：1.COPD患者中,吸烟人群、低收入人群及低文化水平人群比例高,疾病对患者的营养状况、生活质量及心理状况均有影响。 2.COPD患者对自身疾病的认识差,其认识水平与文化程度、收入水平呈正相关。 3.患者肺功能损害程度与其生活质量、营养状况呈负相关,和其呼吸困难症状严重程度、抑郁焦虑程度呈正相关。 4.以呼吸操锻炼为主的综合肺康复训练可减轻患者呼吸困难症状,改善患者生活质量,减缓肺功能下降。
[Abstract]:Objective: to investigate the patients with chronic obstructive pulmonary disease (COPD) by means of questionnaire, follow up regularly, monitor the state of disease and the dynamic changes of pulmonary function, instruct the patients to exercise correctly and urge them to exercise their breathing exercises. To investigate the current diagnosis and treatment status of patients with chronic obstructive pulmonary disease (COPD), and compare with the control group to understand whether the comprehensive intervention based on pulmonary function exercise can alleviate the symptoms, improve the quality of life and improve the pulmonary function of the patients. Methods: a total of 100 COPD patients from January 2012 to June 2012 were randomly selected and investigated by questionnaire and pulmonary function test. 86 patients were randomly divided into control group and intervention group. 42 patients in the intervention group were instructed to correctly exercise their breathing exercises and the patients in the intervention group were followed up by telephone for 6 months. After 6 months, all the patients were visited back again, and the questionnaire survey and pulmonary function examination were carried out. Collate and analyze the collected data. Results among 100 COPD patients, 86 were male and 14 were female. The average age was 65.98 卤8.81). 33 people had occupational dust smoke exposure history. 31 families had respiratory diseases. The average smoking index was 43.21 卤34.85 per year. In the past 12 months, the median number of acute exacerbations for 100 patients was 1 and the median medical cost for acute exacerbation was $800. The average score of disease awareness score was 4.15 卤2.24). There was a positive correlation between the level of cognition and the level of education and income. The average body mass index (BMI) was 21.33 卤4.19 kg / m ~ (2). MNAA suggested that 44 people were at risk of malnutrition and 10 patients had malnutrition. The self-rating depression scale (SDS) showed that the average score of 1 person with severe depression was 19.22 卤7.22 卤7.22 卤7.22 卤7.22%. The predicted value of FEV1% was positively correlated with BMI, and negatively correlated with SDS score, cat score, smoking index and acute attack times. After 6 months of pulmonary rehabilitation exercise, there was a negative correlation between the predicted value and the score of mMRC, the smoking index and the number of acute episodes. The difference of FEV1% predicted value between the control group and the intervention group was 0.382, P 0.002 / mMRC / F 1.128.P0. 016 / cat / F1.127.P0. 012) there was a significant difference between the control group and the intervention group (P < 0. 05). Conclusions: 1. The proportion of smoking, low income and low education in COPD patients is high, and disease has influence on nutritional status, quality of life and psychological status of COPD patients. 2. COPD patients have poor understanding of their own diseases. Its understanding level and education level, income level positive correlation. 3. 3. The degree of pulmonary dysfunction was negatively correlated with quality of life and nutritional status, and positively correlated with the severity of dyspnea and depression and anxiety. 4. Comprehensive pulmonary rehabilitation training with respiratory exercise can alleviate dyspnea symptoms, improve patients' quality of life and slow down the decline of pulmonary function.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9

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