摘要
目的本研究通过寻找影响慢性阻塞性肺疾病（COPD）患者病情转归的生物-心理-社会高危因素，分析COPD患者就医行为的影响因素，为老年COPD患者提供有导向的干预措施，为政府医疗决策和医疗资源分配提供相关依据。方法2014年7月开始随访研究对象，内容包括COPD患者一般情况、病情分级、生存质量问卷。每月进行1次电话访问及宣教，每半年进行1次院内COPD宣教，记录患者参加健康教育次数及依从性情况，2015年12月结束随访进行最后的生存质量问卷调查及病情分级，根据病情进行病情转归分组：病情加重／死亡组、病情无改变组、病情好转组。应用多项Logitic回归，寻找影响COPD患者就诊及转归的生物、心理、社会因素；应用方差分析进行不同病情转归组组间、组内生存质量各领域得分比较，找出病情转归与生存质量关系。结果医保报销比例≥70％、健康教育依从性高、无合并症、研究开始病情较轻（A／B）患者病情好转的可能分别是报销比例少或全自费、健康教育依从性低、有合并症、病情较重（C／D）患者的10．35倍、2．147倍、5．791倍、4．51倍（P〈0．05）。病情加重／死亡组研究结束时生理领域、心理领域、环境领域得分明显低于研究前（P〈0．05）；病情无改变组研究结束得分心理领域明显高于研究前（P〈0．05）；病情好转组研究结束生理领域得分明显高于研究前（P〈0．05）。研究前病情好转组生存质量各领域得分明显高于病情加重／死亡组（P〈0．05）；病情无改变组社会关系领域、环境领域均值明显高于病情加重／死亡组（P〈0．01）。研究结束病情好转组及病情无改变组生存质量各领域得分均明显高于病情加重组（P〈0．05）。结论医保报销比例高、健康教育依从性高、无合并症、研究开始病情分级较轻是病情好转的保护性因素；患者体形偏瘦或正常、急性发作次数频繁、健康教育依从性低是患者病情加重的危险因素；生存质量较高患者病情好转或稳定的可能性大；病情好转或无加重组生存质量也较病情加重组升高。
Objective To provide direct interventions for patients with chronic obstructive pulmonary disease （COPD） and relevant bases of medical decision-making and resource allocation for the government by investigation of those biology-psychology-social factors which influence COPD patients medical behaviors. Methods COPD patients were followed in July in 2014 with general conditions, severity grading and questionnaire of quality of life （QOL）. Telephoned patients every month, processed the health education every six months and recorded their attendance times and their compliance status.The study ended in December 201,5. The final QOL questionnaire investigation was proceeded and those objects were divided into different groups according their outcomes： aggravating group, illness group without change, improved group. Multinomial Logistic regression were used to find those biological psychological social factors that influenced these COPD patients＇ diagnosis and outcome. Variance analysis were used in groups or between-group to find out the relationship between prognosis and QOL. Results Patients with reimbursement proportion 70% higher, better compliance with health education, no complications,illness lighter （A/B） in the beginning would get better than the others （ OR ： 10.35 vs 2. 147 vs 5. 791 vs 1.51, P 〈 0.05）. Scores of aggravating group patients in the physiological, psychological and environmental area of QOL were significantly lower at the end of the study than that in the beginning of study （ P 〈0.05）. Scores in psychological area of illness group without change were obviously higher at the end of the study than that in the beginning of study （P 〈0.05）. Scores in physiological area of improved group were obviously higher at the end of the study than that in the beginning of study （ P 〈0.05）. In the beginning of the study the QOL scores in all area of improved group patients were obviously higher than that of aggravating group patients （ P 〈0.05）. Scores in social relationship and environmental area of illness group without change patients were obviously higher than that of aggravating group patients （ P 〈0.05）. At the end of the study the QOL scores in all area of both improved or illness group without change patients were obviously higher than that of aggravating group patients （ P 〈0.05）. Conclusions Reimbursement proportion 70% or higher, better compliance, no complications, illness lighter （A/B） are protective factors. Underweight or normal, frequent acute attack and lower compliance are risk factors of COPD. Patients with higher QOI, scores got improved or stable conditions. The QOL scores in both illness group without change or improved group patients are higher than that in aggravating group patients.
作者
曹晓伟
唱浩
王延学
曹隽
孙波
周鹏
崔书正
夏志洁
Cao Xiaowei, Chang Hao, Wang Yanxue, Cao Jun, Sun Bo, Zhou Peng, Cui Shuzheng, Xia Zhijie(Department of Emergency Medicine and Critical Care Medicine, Huashan Hospital North Affiliated to Fudan University, Shanghai 201907, Chin)
出处
《国际呼吸杂志》
2018年第9期652-656,共5页
International Journal of Respiration
基金
上海市宝山区科学技术委员会2014年度科研项目（13-E-37）
