Ma Chun-Lan, Xiao Jun, Wang Ke, Xu Zhi-Bo, Chen Bin, Yin Chun, Feng Yu-Lin
Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2012 Jul;43(4):566-72.
To investigate the major risk factors for acute exacerbations of chronic obstructive pulmonary disease (COPD) and the role of mental status in patients who survived the Wenchuan Earthquake.
A questionnaire survey was conducted in 301 COPD patients from the earthquake and non-earthquake areas in Sichuan one month, three months and 12 months after the Wenchuan Earthquake.
A total of 269 patients with COPD completed this study, which included 133 patients earthquake area and 136 from non-earthquake area. (1) Patients from earthquake area had significant higher incidence of acute exacerbations of COPD than those from non-earthquake area 3 months (0.57 +/- 0.688 vs. 0.40 +/- 0.601) and 12 months (1.82 +/- 1.375 vs. 1.47 +/- 1.366) after the earthquake. (2) Patients from earthquake area had significant higher Modified British Medical Research Council (mMRC) grades of COPD than those from non-earthquake area 12 months (P < 0.05) after the earthquake. (3) Patients from earthquake area had significant higher prevalence of posttraumatic stress disorder (PTSD) and higher scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) than those from non-earthquake area within one month and 3 months after the earthquake. The difference in PTSD prevalence remained significant 12 months after the earthquake. (4) No significant differences in the prevalence of PTSD and the scores of SAS and SDS were found within one month and 3 months after the earthquake, though significant improvements were observed 12 months after the earthquake for both participants from the earthquake and non-earthquake areas (P < 0.01). (5) Patients from earthquake area lived in worse environment than those from non-earthquake area during the first 3 months after the earthquake (P < 0.001). The living environments of both groups improved significantly 12 months later (P < 0.001). (6) Binary logistic regression showed that older age, worse pulmonary function, psychological disorder, worse living environment were risk factors of acute exacerbation of COPD after the Wenchuan Earthquake.
The earthquake caused serious psychological trauma in COPD patients. Older age, worse pulmonary function, psychological disorder, worse living environment are risk factors associated with acute exacerbation of COPD. COPD patients should receive psychotherapy and better living arrangement as early as possible after serious disasters.
探讨慢性阻塞性肺疾病（COPD）急性加重的主要危险因素以及心理状态在汶川地震幸存者中的作用。
在汶川地震后1个月、3个月和12个月，对来自四川地震区和非地震区的301例COPD患者进行问卷调查。
共有269例COPD患者完成本研究，其中地震区133例，非地震区136例。（1）地震后3个月（0.57±0.688比0.40±0.601）和12个月（1.82±1.375比1.47±1.366），地震区患者COPD急性加重的发生率显著高于非地震区患者。（2）地震后12个月，地震区患者慢性阻塞性肺疾病改良英国医学研究委员会（mMRC）分级显著高于非地震区患者（P<0.05）。（3）地震后1个月和3个月内，地震区患者创伤后应激障碍（PTSD）患病率、焦虑自评量表（SAS）和抑郁自评量表（SDS）得分显著高于非地震区患者。地震后12个月，PTSD患病率差异仍有统计学意义。（4）地震后1个月和3个月，PTSD患病率、SAS和SDS得分无显著差异，但地震区和非地震区参与者在地震后12个月均有显著改善（P<0.01）。（5）地震后前3个月，地震区患者的生活环境比非地震区患者差（P<0.001）。12个月后两组的生活环境均有显著改善（P<0.001）。（6）二元逻辑回归显示，年龄较大、肺功能较差、心理障碍、生活环境较差是汶川地震后COPD急性加重的危险因素。
地震给COPD患者造成了严重的心理创伤。年龄较大、肺功能较差、心理障碍、生活环境较差是与COPD急性加重相关的危险因素。严重灾难后，COPD患者应尽早接受心理治疗和改善生活安排。
