自我管理计划对晚期慢性阻塞性肺疾病患者病情加重的疗效。
Efficacy of a self-management plan in exacerbations for patients with advanced COPD.
作者信息
Sánchez-Nieto Juan Miguel, Andújar-Espinosa Rubén, Bernabeu-Mora Roberto, Hu Chunshao, Gálvez-Martínez Beatriz, Carrillo-Alcaraz Andrés, Álvarez-Miranda Carlos Federico, Meca-Birlanga Olga, Abad-Corpa Eva
机构信息
Division of Pneumology, Hospital Morales Meseguer; University of Murcia.
Division of Pneumology, Hospital Arrixaca, Murcia.
出版信息
Int J Chron Obstruct Pulmon Dis. 2016 Aug 17;11:1939-47. doi: 10.2147/COPD.S104728. eCollection 2016.
BACKGROUND
Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.
METHODS
Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.
RESULTS
After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191).
CONCLUSION
The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.
背景
自我管理干预可改善多种慢性病的不同结局变量。其在慢性阻塞性肺疾病（COPD）中的作用尚未明确确立。我们评估了一种名为自我管理项目的干预措施对晚期COPD患者因疾病加重而需要住院治疗的影响。
方法
在两家医院进行的多中心随机研究，随访1年。所有患者均患有重度或极重度COPD，且在前一年因COPD加重至少去过一次急诊科或住院治疗过一次。干预措施包括一次关于该疾病主要特征的小组教育课程、在开始时和第3个月进行的一次关于吸入技术的个人培训课程，以及一份包含稳定期和加重期体育活动及治疗指导的书面行动计划。我们确定了每位患者每年与COPD相关的住院和急诊就诊次数总和。次要终点包括去急诊科就诊的患者数量、因加重而住院的患者数量、抗生素和糖皮质激素的使用情况、住院时间以及全因死亡率。
结果
1年后，接受干预的患者组中，因COPD加重而去急诊科就诊或住院的发生率从1.37降至0.89（P = 0.04），加重次数从52次降至42次。该组中因COPD加重而住院治疗的患者数量为19例（40.4%），而另一组为20例（52.6%）（P = 0.26）；去急诊科就诊的患者数量为9例（19.1%），而另一组为14例（36.8%）（P = 0.06），也较低。干预组抗生素的摄入量较高，而糖皮质激素的使用略低，尽管差异无统计学意义（P = 0.30）。两组在住院时间（P = 0.154）或总体死亡率（P = 0.191）方面也无差异。
结论
为晚期COPD患者实施自我管理项目可减少需要住院治疗的病情加重情况。
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