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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
吴海玲,赵双燕,刘鹏,张媛,赵黎黎,田银军,胡晓凤,刘前桂.中期照护模式对老年中重度慢性阻塞性肺疾病患者的康复治疗效果[J].中华老年多器官疾病杂志,2018,17(6):412~415
中期照护模式对老年中重度慢性阻塞性肺疾病患者的康复治疗效果
Efficacy of intermediate care mode on rehabilitation of elderly patients with moderate or severe chronic obstructive pulmonary disease
投稿时间:2018-01-20  修订日期:2018-03-27
DOI:10.11915/j.issn.1671-5403.2018.06.092
中文关键词:  老年人;慢性阻塞性肺疾病;中期照护;呼吸康复;BODE评分
英文关键词:aged; chronic obstructive pulmonary disease; intermediate care; respiratory rehabilitation; BODE score
基金项目:首都卫生发展科研专项(2016-1-2194)
作者单位E-mail
吴海玲 北京老年医院呼吸康复科,北京 100095  
赵双燕 北京老年医院呼吸康复科,北京 100095  
刘鹏 中国医科大学临床三系,沈阳 110122  
张媛 北京老年医院呼吸康复科,北京 100095  
赵黎黎 北京老年医院呼吸康复科,北京 100095  
田银军 北京老年医院呼吸康复科,北京 100095  
胡晓凤 北京老年医院呼吸康复科,北京 100095  
刘前桂 北京老年医院呼吸康复科,北京 100095 lqg9349@163.com 
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中文摘要:
      目的 探讨中期照护(IC)模式对老年中、重度慢性阻塞性肺疾病(COPD)患者的康复疗效。方法 选取2015年1月至2017年6月在北京老年医院因COPD急性发作住院经治疗病情好转且资料完整的中、重度COPD患者共124例,应用随机数字表法分为IC组及对照组各62例。IC组在一般临床治疗的基础上采用IC模式;对照组仅采用一般内科治疗。比较治疗前后及治疗15、30、60 d后两组BODE指数(体质量指数、气流阻塞程度、呼吸困难及运动能力)评分、健康相关生存质量评分(HRQL)、血气分析等指标,记录跌倒评分、急性发作次数和再住院次数。采用SPSS 20.0进行统计分析,计量资料以均数±标准差表示,组间比较采用t检验,计数资料用百分率表示,组间比较用χ2检验。结果 两组治疗前各指标比较差异均无统计学意义(P>0.05);与治疗前自身相比,2组治疗后15 d,第1秒用力呼气容积/用力肺活量(FEV1/FVC,FEV1%)、6分钟步行试验(6MWT)、体质量指数(BMI)、圣乔治呼吸问卷(SGRQ)、改良的英国医学研究委员会呼吸困难量表(mMRC)评分、BODE评分、PaO2、PaCO2、跌倒评分差异无统计学意义(P>0.05);治疗后30、60 d,以上指标改善显著(P<0.05)。治疗后15、30及60 d两组比较,IC组FEV1%、6MWT、BMI、SGRQ、PaO2、PaCO2 均有显著改善(P<0.05),mMRC评分降低不明显(P>0.05);治疗后15 d两组 BODE指数评分差异无统计学意义(P>0.05),治疗后30 d及60 d差异显著(P<0.05)。治疗后30 d两组跌倒风险评分、急性发作次数、再住院次数均无显著改善(P>0.05);治疗后60 d则明显降低(P<0.05)。结论 采用IC模式管理老年中重度COPD患者可显著降低患者的BODE评分,提高 PaO2,降低PaCO2,降低跌倒风险、急性发作次数及再住院次数。
英文摘要:
      Objective To determine the therapeutic effect of intermediate care (IC) mode on rehabilitation of the elderly patients with moderate or severe chronic obstructive pulmonary diseases (COPD). Methods A total of 124 elderly patients with whole clinical data, suffering from acute exacerbation of COPD and then gotten improved after hospitalization in Beijing Geriatric Hospital during January 2015 and June 2017 were recruited in this study. They were randomly divided into IC group and control group(n=62 for each group). The patients of the IC group adopted IC mode on the basis of general clinical treatment, while those of the control group was treated only with general internal medicine. Their BODE index [body mass index (BMI), measure of airflow obstruction, dyspnea score and exercise capacity], health related quality of life (HRQL), results of blood gas analysis were compared before and in 15,0 and 60 d after the treatment.The fall scores, times of acute exacerbation of COPD, and re-hospitalization were recorded. SPSS statistics 20.0 was used for data analysis. The measurement data were expressed as mean±standard deviation, and Student′s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results There were no statistical differences in all indicators between the 2 groups before treatment (P>0.05). Compared with the following indicators before treatment, no obvious differences were seen between the 2 groups in 15 d after the treatment, including forced expiratory volume in one second/forced vital capacity (FEV1/FVC, FEV1%), 6-minute walking test (6MWT), BMI, Saint George′s Respiratory Questionnaire (SGRQ), modified British Medical Research Committee respiratory distress scale (mMRC) score, BODE score, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and fall score (P>0.05). But the above indicators were significantly improved in 30 and 60 d after treatment (P<0.05). After treatment, the improvement of FEV1%, 6MWT, BMI, SGRQ, PaO2 and PaCO2 in the IC group was significant in 30 and 60 d (P<0.05), and the decrease of mMRC score was not obvious (P>0.05). There was no notable difference in BODE index between the 2 groups in 15 d (P>0.05), but the differences were significant in 30 and 60 d after treatment (P<0.05). After 30 days′ treatment, there was no significant improvement in the risk score, times of acute exacerbation and re-hospitalization in the 2 groups (P>0.05), but the 3 indicators were significantly reduced after 60 days′ treatment (P<0.05). Conclusion IC mode can significantly reduce the BODE index, improve PaO2 and decrease PaCO2, lower the incidence of falls, times of acute exacerbation and re-hospitalization in the elderly patients with moderate and severe COPD.
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