中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2011年
3期
171-174
,共4页
李凡%徐迅%张学民%蔡映云%朱王汇%傅欢英%沈朝英%陆元英%庄棋军%殷建峰%李苏华%殷为文%周美华%陈小丽
李凡%徐迅%張學民%蔡映雲%硃王彙%傅歡英%瀋朝英%陸元英%莊棋軍%慇建峰%李囌華%慇為文%週美華%陳小麗
리범%서신%장학민%채영운%주왕회%부환영%침조영%륙원영%장기군%은건봉%리소화%은위문%주미화%진소려
肺疾病,慢性阻塞性%社区卫生中心%疾病管理
肺疾病,慢性阻塞性%社區衛生中心%疾病管理
폐질병,만성조새성%사구위생중심%질병관리
Pulmonary disease,chronic obstructive%Community health centers%Disease management
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.
目的 評價社區衛生服務中心管理慢性阻塞性肺疾病(COPD)患者的效果.方法 採用準實驗設計方法,以上海市鬆江區小昆山和新浜兩鄉鎮社區衛生服務中心服務區域內2008年登記的COPD患者為研究對象.小昆山社區作為COPD管理組,管理內容包括:對社區全科醫生做COPD防治知識培訓,社區衛生服務中心基本防治藥物配置,COPD患者及傢屬的COPD防治基本知識教育.新浜社區為對照組.結果 兩社區肺功能檢查診斷齣COPD 132例,小昆山61例,新浜71例.完成1年隨訪後資料完整的小昆山47例,新浜55例.小昆山初訪時吸煙者5例,1年後成功戒煙3例;新浜初訪時吸煙者19例,研究結束時無戒煙者.比較兩箇社區COPD患者1年中癥狀、生存質量、肺功能、呼吸睏難評分及6 min步行距離,第1秒用力呼氣容積FEV1和癥狀的評估差值的差異無統計學意義,生存質量方麵小昆山患者從初訪時的46.96下降到1年後的39.12,降低-7.84;新浜患者從56.55上升到62.11,上升5.56;小昆山6 min步行距離從初訪時的361.66下降到1年後的354.26,而新浜從398.07下降到351.18;小昆山功能性呼吸睏難評估從初次0.40下降到0.34,而新浜從0.95上升到1.00;1年裏,小昆山和新浜患者急診分彆為13例次和53例次,住院分彆為4例次和5例次,新浜有4例因COPD急性加重死亡,小昆山則無.結論 提高社區全科醫生、患者和傢屬的COPD防治能力和防治水平,可以改善患者的生存質量,減少急性髮作和住院次數,減輕呼吸睏難程度和延緩6 min步行距離的下降.
목적 평개사구위생복무중심관리만성조새성폐질병(COPD)환자적효과.방법 채용준실험설계방법,이상해시송강구소곤산화신빈량향진사구위생복무중심복무구역내2008년등기적COPD환자위연구대상.소곤산사구작위COPD관리조,관리내용포괄:대사구전과의생주COPD방치지식배훈,사구위생복무중심기본방치약물배치,COPD환자급가속적COPD방치기본지식교육.신빈사구위대조조.결과 량사구폐공능검사진단출COPD 132례,소곤산61례,신빈71례.완성1년수방후자료완정적소곤산47례,신빈55례.소곤산초방시흡연자5례,1년후성공계연3례;신빈초방시흡연자19례,연구결속시무계연자.비교량개사구COPD환자1년중증상、생존질량、폐공능、호흡곤난평분급6 min보행거리,제1초용력호기용적FEV1화증상적평고차치적차이무통계학의의,생존질량방면소곤산환자종초방시적46.96하강도1년후적39.12,강저-7.84;신빈환자종56.55상승도62.11,상승5.56;소곤산6 min보행거리종초방시적361.66하강도1년후적354.26,이신빈종398.07하강도351.18;소곤산공능성호흡곤난평고종초차0.40하강도0.34,이신빈종0.95상승도1.00;1년리,소곤산화신빈환자급진분별위13례차화53례차,주원분별위4례차화5례차,신빈유4례인COPD급성가중사망,소곤산칙무.결론 제고사구전과의생、환자화가속적COPD방치능력화방치수평,가이개선환자적생존질량,감소급성발작화주원차수,감경호흡곤난정도화연완6 min보행거리적하강.
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 dyspnea in patients at Xiaokunshan fell to 0.34 from 0.40 at their first visit, meanwhile that in patients at Xinbang increased to 1.00 from 0.95(P =0.038). During the one-year follow-up, 13 patients at Xiaokunshan and 53 at Xinbang visited emergency departments for treatment, and four at Xiaokunshan were hospitalized and none died, and five at Xinbang were hospitalized due to acute exacerbation of COPD and four of them died. Conclusions The study suggests that strengthening prevention and treatment for COPD patients at community level by general practitioners, patients themselves and their family members can improve their quality of life, reduce emergency visits and hospitalization, alleviate dyspnea symptoms and delay the decline of 6MWD.
