本文選題：COPD + 診療現(xiàn)狀�。� 參考：《中南大學(xué)》2013年碩士論文

【摘要】：目的：通過對(duì)慢性阻塞性肺疾病患者進(jìn)行問卷調(diào)查、定期隨訪、監(jiān)測(cè)患者病情及肺功能動(dòng)態(tài)變化、指導(dǎo)患者正確進(jìn)行肺功能鍛煉及督促患者行呼吸操鍛煉等綜合干預(yù)模式,研究了解慢性阻塞性肺疾病(COPD)患者目前診療現(xiàn)狀,并與對(duì)照組比較以了解以肺功能鍛煉為主的綜合干預(yù)是否能減輕患者癥狀、提高患者生活質(zhì)量、改善患者肺功能狀況。 方法：隨機(jī)抽取2012年01月至2012年06月我院呼吸科就診的COPD患者100名,對(duì)全部患者進(jìn)行問卷調(diào)查及肺功能檢查。將其中86名患者進(jìn)行隨機(jī)分組,分為對(duì)照組和干預(yù)組。指導(dǎo)干預(yù)組42名患者正確進(jìn)行呼吸操鍛煉并對(duì)干預(yù)組患者進(jìn)行6個(gè)月的電話隨訪。6個(gè)月后再次對(duì)全部患者進(jìn)行回訪,并對(duì)其行問卷調(diào)查及肺功能檢查。對(duì)所收集的數(shù)據(jù)整理,進(jìn)行數(shù)據(jù)統(tǒng)計(jì)和分析。 結(jié)果：100位COPD患者中男性病人86人,女性14人。平均年齡(65.98±8.81)歲。33人有職業(yè)粉塵煙霧暴露史。31人家族中有相關(guān)呼吸系統(tǒng)疾病。其平均吸煙指數(shù)為(43.21±34.85)包年。過去12個(gè)月中,100名患者急性加重次數(shù)中位數(shù)為1次,因急性加重產(chǎn)生的醫(yī)療費(fèi)用的中位數(shù)為800元。疾病認(rèn)識(shí)評(píng)分的平均得分為(4.15±2.24)分。患者的認(rèn)識(shí)水平與其教育程度、收入水平呈正相關(guān)。體重指數(shù)(BMI)均值為(21.33±4.19)kg/m2。微型營養(yǎng)評(píng)價(jià)問卷(MNA)提示44人存在營養(yǎng)不良危險(xiǎn),有10名患者明確存在營養(yǎng)不良。抑郁自評(píng)量表(SDS)提示8人存在輕度抑郁,1人為重度抑郁。CAT平均得分為(19.22±7.22)。FEV1%預(yù)計(jì)值與BMI呈正相關(guān),與SDS評(píng)分、CAT評(píng)分、mMRC評(píng)級(jí)、吸煙指數(shù)、急性發(fā)作次數(shù)呈負(fù)相關(guān)。6個(gè)月肺康復(fù)鍛煉后,對(duì)照組和干預(yù)組之間的FEV1%預(yù)計(jì)值的差值(F=0.382, P=0.002)、mMRC評(píng)級(jí)(F=1.128.P=0.016)、CAT評(píng)分(F=1.127.P=0.012)均存在統(tǒng)計(jì)學(xué)差異。 結(jié)論：1.COPD患者中,吸煙人群、低收入人群及低文化水平人群比例高,疾病對(duì)患者的營養(yǎng)狀況、生活質(zhì)量及心理狀況均有影響。 2.COPD患者對(duì)自身疾病的認(rèn)識(shí)差,其認(rèn)識(shí)水平與文化程度、收入水平呈正相關(guān)。 3.患者肺功能損害程度與其生活質(zhì)量、營養(yǎng)狀況呈負(fù)相關(guān),和其呼吸困難癥狀嚴(yán)重程度、抑郁焦慮程度呈正相關(guān)。 4.以呼吸操鍛煉為主的綜合肺康復(fù)訓(xùn)練可減輕患者呼吸困難癥狀,改善患者生活質(zhì)量,減緩肺功能下降。
[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 鹵8.81). 33 people had occupational dust smoke exposure history. 31 families had respiratory diseases. The average smoking index was 43.21 鹵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 鹵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 鹵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 鹵7.22 鹵7.22 鹵7.22 鹵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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9

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