文章摘要
江梅,马锦芳.慢性阻塞性肺疾病患者对急性 加重认知的调查[J].中华流行病学杂志,2013,34(10):1030-1034
慢性阻塞性肺疾病患者对急性 加重认知的调查
Comprehension and recognition of acute exacerbation among chronic obstructive pulmonary disease patients
收稿日期:2013-05-17  出版日期:2014-10-08
DOI:10.3760/cma.j.issn.0254—6450.2013.10.020
中文关键词: 慢性阻塞性肺疾病|急性加重|认知
英文关键词: Chronic obstructive pulmonary diseas|Acute exacerbatio|Recognition
基金项目:广东省科技计划(20098060700082)
作者单位E-mail
江梅 广州医学院第一附属医院广州呼吸疾病研究所呼吸疾病国家重点实验室, 广州 510120
中山大学公共卫生学院流行病 与卫生统计学系 
majfl216@163.com 
马锦芳 广州医学院第一附属医院广州呼吸疾病研究所呼吸疾病国家重点实验室, 广州 510120
 
 
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中文摘要:
      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1一12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3l(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.o%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。
英文摘要:
      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).Methads A cross-sectional,interview—based survey was carried.Pulmonary function tests were conducted inpatients with COPD between January and December 2010 in Guangzhou.Resdts 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.O%),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,Ⅳ respectively,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 ofAECOPD.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,mcreasmg amount on sputum.purulent sputum or coughing.When exacerbation occurred,87.6%ofthe patients would recognize the signs.with 75.4%ofthe patients would go to the outpatient clinic. ResultsThe mean vAS scores on the occurrence of next exacerbations were 37.9(±1 9.7). 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 all 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 uD at either outpatient or inpatient medical seRings 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 9 11 patients.only 1 0.3%of them were aware of the worsening condition.2 1.0%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 ofAECOPD before。most ofthem(83.2%)thought that exacerbation affected their working condition and daily activities.while up to 9 1.6%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 109istic 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
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