如何更好解决COPD呼吸困难症状困扰---典型病例分享---长沙会议.ppt

* Abstention decondition * 慢阻肺导致的呼吸困难给患者的基本日常生活造成了沉重的负担，严重影响到患者的生活质量。 芬兰一项调查研究评价了慢阻肺患者的“身体运动”情况，以及与“身体运动”/“身体运动不足”相关的临床特征。该研究中的719例受试者来自芬兰赫尔辛基和土尔库大学中心医院2005～2007年收治的慢阻肺患者。问卷内容包括：患者的运动习惯和其他日常活动，影响运动的潜在限制，健康相关性生活质量和劳力性呼吸困难的主观感觉。结果显示：患者报道的主观呼吸困难MRC评分日常活动水平(r = -0.37, P0.01)、致残评分(r = -0.46, P0.01)和健康相关性生活质量评分(r = -0.40,P0.01)呈明显的负相关性。 Katajisto M, Kupiainen H, Rantanen P, et al. Physical inactivity in COPD and increased patient perception of dyspnea. Int J Chron Obstruct Pulmon Dis. 2012;7:743-55. * * 综上所述，慢阻肺导致的呼吸困难、以及进一步引起的活动受限和生活质量下降构成了一个恶性循环1： 适当运动能显著改善慢阻肺患者的功能状态和生活质量，进而降低患者死亡率2； 但是，呼吸困难会迫使慢阻肺患者通过减少活动来缓解不适症状2； 而活动不足又将进一步加速肺功能下降，成为慢阻肺急性加重的一个重要危险因素，严重影响患者预后2。 以上提示，改善慢阻肺患者的呼吸困难症状是打破上述恶性循环、提高患者运动能力和生活质量的关键所在。 1. Cooper CB. Am J Med 2006; 119:S21-S31. 2. Katajisto M, et al. Int J Chron Obstruct Pulmon Dis. 2012;7:743-55. * * However, regarding mortality, the trend was not the same, as group B had higher mortality than group C (log-rank test, P = 0.02), which is also shown in Figure 2 depicting survival according to both GOLD 1–4 and GOLD A–D. The difference in survival between groups B and C remained statistically significant after inclusion of age and sex in the model (Cox proportional hazards; P = 0.03). In particular, the mortality from cardiovascular diseases and cancer was significantly higher in group B compared with group A (log-rank test, P 0.001 for both) and in group D compared with group C (log-rank test, P = 0.008 for cardiovascular deaths and P = 0.01 for cancer deaths). A similar trend was seen regarding hospital admissions due to all causes, where group B experienced a higher risk of admission than group C (log-rank test, P 0.001). Rationale: The new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations. Objectives: To investigate the abilities of this stratification to predict the