中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2013年
10期
1030-1034
,共5页
慢性阻塞性肺疾病%急性加重%认知
慢性阻塞性肺疾病%急性加重%認知
만성조새성폐질병%급성가중%인지
Chronic obstructive pulmonary disease%Acute exacerbation%Recognition
目的 了解慢性阻塞性肺疾病(COPD)患者对COPD急性加重(AECOPD)认知状况,并探讨其相关因素.方法 采用横断面设计,对2010年1-12月广州呼吸疾病研究所963例COPD患者进行问卷调查和肺功能测定,并通过logistic回归筛选出患者AECOPD认知的相关影响因素.结果 (1)COPD患者问卷有效率为94.6％(911/963)；其中男性738例(81.0％),女性173例(19.0％),平均年龄(69.2±9.1)岁；I～Ⅳ级COPD患者分别有31(3.4％)、363 (39.8％)、340(37.3％)、177(19.4％)例,其中554例(60.8％)处于急性加重期；吸烟指数为(45.6±25.0)包年.(2)有573例(62.9％)听说过COPD,50.4％(459/911)的患者从未听过AECOPD,即使在听说过COPD的患者中,也仅有3.4％(20/573)认为自己完全了解AECOPD.在了解AECOPD的452名患者中认为其主要症状表现为气促加重、痰量增加、脓性痰、咳嗽增加,分别占87.2％、59.1％、30.5％和33.4％；当可能发生AECOPD时,知道预警症状为呼吸困难、咳嗽增加、咳痰增加者分别占87.6％、55.5％、45.1％；出现AECOPD时,75.4％的患者选择门诊治疗.患者对再次发生AECOPD担忧的VAS评分为(37.9±19.7)分,主要为担心症状加重(36.7％)和肺功能下降(29.6％).(3) 82.7％(753/911)的患者曾检测过肺功能,但只有30.5％(230/753)的患者知道检测结果；69.5％ (523/753)的患者既往诊断为COPD,平均病程(7.0±6.0)年；在听说过AECOPD的452例患者中,过去1年内急性加重的次数为(4.3±4.2)次,因急性加重到医院就诊或住院的次数为(4.8±3.2)次,急性加重平均持续时间(1.84±2.52)周、恢复时间(3.09±4.21)周,两次急性加重平均间隔时间(13.17±10.91)周.(4)911例中只有10.3％认为自己健康状况好,21.0％认为易患病,58.4％认为健康状况变差,急性加重期的患者比稳定期自我感觉更差.在了解AECOPD的452例患者中,大部分患者(83.2％)认为急性加重影响工作和日常活动；91.6％则认为急性加重影响社交活动,并有沮丧、焦虑、容易生气等负面情绪.(5)在调整年龄、职业、吸烟状况和吸烟指数后,AECOPD患者文化程度越高、经济状况越好、自身COPD分级越高,其行为认知状况越好；男性患者行为认知状态好于女性.结论 COPD患者对AECOPD相关知识的知晓度较低,尤其是受教育水平和经济状况较低及病情相对较轻的患者对疾病的认知程度更低.
目的 瞭解慢性阻塞性肺疾病(COPD)患者對COPD急性加重(AECOPD)認知狀況,併探討其相關因素.方法 採用橫斷麵設計,對2010年1-12月廣州呼吸疾病研究所963例COPD患者進行問捲調查和肺功能測定,併通過logistic迴歸篩選齣患者AECOPD認知的相關影響因素.結果 (1)COPD患者問捲有效率為94.6％(911/963)；其中男性738例(81.0％),女性173例(19.0％),平均年齡(69.2±9.1)歲；I～Ⅳ級COPD患者分彆有31(3.4％)、363 (39.8％)、340(37.3％)、177(19.4％)例,其中554例(60.8％)處于急性加重期；吸煙指數為(45.6±25.0)包年.(2)有573例(62.9％)聽說過COPD,50.4％(459/911)的患者從未聽過AECOPD,即使在聽說過COPD的患者中,也僅有3.4％(20/573)認為自己完全瞭解AECOPD.在瞭解AECOPD的452名患者中認為其主要癥狀錶現為氣促加重、痰量增加、膿性痰、咳嗽增加,分彆佔87.2％、59.1％、30.5％和33.4％；噹可能髮生AECOPD時,知道預警癥狀為呼吸睏難、咳嗽增加、咳痰增加者分彆佔87.6％、55.5％、45.1％；齣現AECOPD時,75.4％的患者選擇門診治療.患者對再次髮生AECOPD擔憂的VAS評分為(37.9±19.7)分,主要為擔心癥狀加重(36.7％)和肺功能下降(29.6％).(3) 82.7％(753/911)的患者曾檢測過肺功能,但隻有30.5％(230/753)的患者知道檢測結果；69.5％ (523/753)的患者既往診斷為COPD,平均病程(7.0±6.0)年；在聽說過AECOPD的452例患者中,過去1年內急性加重的次數為(4.3±4.2)次,因急性加重到醫院就診或住院的次數為(4.8±3.2)次,急性加重平均持續時間(1.84±2.52)週、恢複時間(3.09±4.21)週,兩次急性加重平均間隔時間(13.17±10.91)週.(4)911例中隻有10.3％認為自己健康狀況好,21.0％認為易患病,58.4％認為健康狀況變差,急性加重期的患者比穩定期自我感覺更差.在瞭解AECOPD的452例患者中,大部分患者(83.2％)認為急性加重影響工作和日常活動；91.6％則認為急性加重影響社交活動,併有沮喪、焦慮、容易生氣等負麵情緒.(5)在調整年齡、職業、吸煙狀況和吸煙指數後,AECOPD患者文化程度越高、經濟狀況越好、自身COPD分級越高,其行為認知狀況越好；男性患者行為認知狀態好于女性.結論 COPD患者對AECOPD相關知識的知曉度較低,尤其是受教育水平和經濟狀況較低及病情相對較輕的患者對疾病的認知程度更低.
목적 료해만성조새성폐질병(COPD)환자대COPD급성가중(AECOPD)인지상황,병탐토기상관인소.방법 채용횡단면설계,대2010년1-12월엄주호흡질병연구소963례COPD환자진행문권조사화폐공능측정,병통과logistic회귀사선출환자AECOPD인지적상관영향인소.결과 (1)COPD환자문권유효솔위94.6％(911/963)；기중남성738례(81.0％),녀성173례(19.0％),평균년령(69.2±9.1)세；I～Ⅳ급COPD환자분별유31(3.4％)、363 (39.8％)、340(37.3％)、177(19.4％)례,기중554례(60.8％)처우급성가중기；흡연지수위(45.6±25.0)포년.(2)유573례(62.9％)은설과COPD,50.4％(459/911)적환자종미은과AECOPD,즉사재은설과COPD적환자중,야부유3.4％(20/573)인위자기완전료해AECOPD.재료해AECOPD적452명환자중인위기주요증상표현위기촉가중、담량증가、농성담、해수증가,분별점87.2％、59.1％、30.5％화33.4％；당가능발생AECOPD시,지도예경증상위호흡곤난、해수증가、해담증가자분별점87.6％、55.5％、45.1％；출현AECOPD시,75.4％적환자선택문진치료.환자대재차발생AECOPD담우적VAS평분위(37.9±19.7)분,주요위담심증상가중(36.7％)화폐공능하강(29.6％).(3) 82.7％(753/911)적환자증검측과폐공능,단지유30.5％(230/753)적환자지도검측결과；69.5％ (523/753)적환자기왕진단위COPD,평균병정(7.0±6.0)년；재은설과AECOPD적452례환자중,과거1년내급성가중적차수위(4.3±4.2)차,인급성가중도의원취진혹주원적차수위(4.8±3.2)차,급성가중평균지속시간(1.84±2.52)주、회복시간(3.09±4.21)주,량차급성가중평균간격시간(13.17±10.91)주.(4)911례중지유10.3％인위자기건강상황호,21.0％인위역환병,58.4％인위건강상황변차,급성가중기적환자비은정기자아감각경차.재료해AECOPD적452례환자중,대부분환자(83.2％)인위급성가중영향공작화일상활동；91.6％칙인위급성가중영향사교활동,병유저상、초필、용역생기등부면정서.(5)재조정년령、직업、흡연상황화흡연지수후,AECOPD환자문화정도월고、경제상황월호、자신COPD분급월고,기행위인지상황월호；남성환자행위인지상태호우녀성.결론 COPD환자대AECOPD상관지식적지효도교저,우기시수교육수평화경제상황교저급병정상대교경적환자대질병적인지정도경저.
Objective The aim of the study was to gain insight of comprehension and recognition on the exacerbations and related factors of chronic obstructive pulmonary disease (COPD),so as to provide evidence for treatment on acute exacerbations of COPD (AECOPD).Methods A cross-sectional,interview-based survey was carried.Pulmonary function tests were conducted in patients with COPD between January and December 2010 in Guangzhou.Results 1)Questionnaires on 911 COPD patients were available,with a efficient rate as 94.6％ (911/963) including 738 men (81.0％) and 173 women (19.0％),with mean age as 69.2 years old (± 9.1 years).Patients with COPD were 31 (3.4％),363 (39.8％),340 (37.3％) and 177 (19.4％) at stages Ⅰ,Ⅱ,Ⅲ,Ⅳrespectively,with 60.8％(554/911)were exacerbation.The mean index for smoking was 45.6 pack/year (± 25.0).2)Only 573 patients were aware of COPD and 50.4％ (459/911) patients had never heard of AECOPD.Among 452 patients who had heard ofAECOPD,87.2％,59.1％,30.5％ and 33.4％of them viewed that the exacerbation of COPD were mainly characterized as:increasing status on short of breath,increasing amount on sputum,purulent sputum or coughing.When exacerbation occurred,87.6％ of the patients would recognize the signs,with 75.4％ of the patients would go to the outpatient clinic.The mean VAS scores on the occurrence of next exacerbations were 37.9 (± 19.7).3) 753 (82.7％) patients had been tested for pulmonary function,but only 30.5％ of them were aware of the results.523 (69.5％) patients were previously diagnosed with COPD,with an average course of 7 years.Among the 452 patients who had heard of AECOPD before the onset of disease,the mean time of exacerbation in the past 1 year was 4.3,and the mean time of ending up at either outpatient or inpatient medical settings was 4.8.The average duration of exacerbation and time of recovery was 1.84 and 3.09 weeks.Duration of stable state between the 2 exacerbation episodes was 13.17 weeks.4) Among 911 patients,only 10.3％ of them were aware of the worsening condition.21.0％ recognized of the greater susceptibility to the disease and 58.4％ believed that their health gradually deteriorating.More seen among patients under exacerbation than those who were stable.Among 452 patients who had heard of AECOPD before,most of them (83.2％) thought that exacerbation affected their working condition and daily activities,while up to 91.6％ of them thought that their social events were also negatively affected.Exacerbation also caused negative emotions as depression,anxiety,and anger.5) After adjusted for age,occupation,smoking status and index,factors as:sex,education level,economic situation,and stage of COPD were found affecting the AECOPD cognitive,from data under multivariate logistic regression analysis.Conclusion Patients with COPD were poor on the awareness of AECOPD,particularly among patients with low income,low education levels,low income or at low COPD stage.
