摘要
目的探讨基于慢性阻塞性肺疾病全球倡议(GOLD)指南的数字化管理路径对中重度慢性阻塞性肺疾病(COPD)患者急性加重频率、呼吸肌功能及生活质量的影响,以期为临床决策的制定提供参考。方法选择2020年1月—2024年9月苏北人民医院、扬州市第二人民医院招募的100例中重度COPD患者作为研究对象。采用随机数字表法将患者随机分为常规干预组、排痰组、肺康复锻炼组和给药器用药组,每组25例。常规干预组患者接受常规健康教育及随访,排痰组患者在常规干预基础上增加数字化辅助排痰训练,肺康复锻炼组患者实施数字化呼吸肌训练,给药器用药组患者采用智能给药器管理系统提升用药依从性。干预周期为48周。比较4组患者干预期间中重度急性加重次数、首次急性加重时间,以及肺功能指标[第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC比值、最大呼气中期流量(MMEF)]、改良的英国医学研究委员会呼吸困难评分(mMRC)、Miller咳痰评分、6分钟步行试验(6MWT)及慢性阻塞性肺疾病评估测试(CAT)评分的变化。结果干预后,4组患者的肺功能指标、运动耐力和生活质量均较干预前显著改善。其中,给药器用药组在减少患者中重度急性加重次数、任何程度急性加重次数、延迟首次急性加重时间以及降低CAT评分方面效果最为显著(P<0.05)。排痰组的Miller咳痰评分提升最为明显(P<0.05),表明其排痰能力改善最佳。结论基于GOLD指南的数字化管理路径能有效降低中重度COPD患者的急性加重风险,改善呼吸肌功能、运动耐力和生活质量,其中智能用药管理联合数字化肺康复的综合干预模式效果尤佳。
Objective To investigate the effects of a digital management pathway based on the Global Initiative for Chronic Obstructive Lung Disease(GOLD)guidelines on acute exacerbation frequency,respiratory muscle function,and quality of life in patients with moderate-to-severe chronic obstructive pulmonary disease(COPD),providing references for clinical decision-making.Methods A total of 100 patients with moderate-to-severe COPD recruited from Northern Jiangsu People's Hospital and Yangzhou Second People's Hospital from January 2020 to September 2024 were selected.Using a random number table,patients were assigned to four groups(n=25 each):routine intervention group,expectoration group,pulmonary rehabilitation exercise group,and drug delivery device group.The routine intervention group received standard health education and follow-up.The expectoration group received additional digitally assisted expectoration training.The pulmonary rehabilitation exercise group underwent digital respiratory muscle training.The drug delivery device group used an intelligent drug delivery management system to enhance medication adherence.The intervention lasted 48 weeks.Changes in moderate-to-severe exacerbation frequency,time to first exacerbation,pulmonary function indices(forced expiratory volume in 1 second[FEV1],forced vital capacity[FVC],FEV1/FVC ratio,maximal mid-expiratory flow[MMEF]),modified Medical Research Council(mMRC)dyspnea score,Miller and Jones classification score,6-minute walk test(6MWT)distance,and COPD Assessment Test(CAT)score were compared.Results After intervention,all four groups showed significant improvement in pulmonary function indices,exercise tolerance,and quality of life compared to baseline.The drug delivery device group demonstrated the most significant effects in reducing moderate-to-severe and any-grade exacerbation frequency,delaying the time to first exacerbation,and lowering CAT scores(P<0.O5).The expectoration group showed the most pronounced improvement in Miller and Jones classification score(P<0.O5),indicating optimal enhancement in sputum expectoration ability.Conclusion The GOLD guideline-based digital management pathway effectively reduces acute exacerbation risk and improves respiratory muscle function,exercise tolerance,and quality of life in moderate-to-severe COPD patients.The comprehensive intervention model combining intelligent medication management with digital pulmonary rehabilitation yields particularly favorable outcomes.
作者
陈波
王继兵
闵凌峰
於江泉
金星
尹正录
王建建
孟兆祥
Chen Bo;Wang Jibing;Min Lingfeng;Yu Jiangquan;Jin Xing;Yin Zhenglu;Wang Jianjian;Meng Zhaoxiang(Department of Rehabilitation Medicine,Northern Jiangsu People's Hospital,Yangzhou Jiangsu 225001,China;Department of Respiratory and Critical Care Medicine,Northern Jiangsu People's Hospital,Yangzhou Jiangsu 225001,China;Department of Critical Care Medicine,Northern Jiangsu People's Hospital,Yangzhou Jiangsu 225001,China)
出处
《保健医学研究与实践》
2025年第12期15-23,共9页
Health Medicine Research and Practice
基金
国家卫生健康委医药卫生科技发展研究中心项目(WKZX2024HK0137)。
关键词
慢性阻塞性肺疾病
数字化管理
急性加重
GOLD指南
呼吸肌功能
康复治疗
Chronic obstructive pulmonary disease
Digital management
Acute exacerbation
GOLD guidelines
Respiratory muscle function
Rehabilitation therapy
