西部农村慢性阻塞性肺疾病患者诊治现状及问题

目的 探究农村慢性阻塞性肺疾病（ 简称慢阻肺） 患者的疾病特征、就医模式和获得基本医疗服务的可及性及障碍。方法 在西部农村慢阻肺流行病学调查基础上, 选取诊断为慢阻肺的农村患者为调查对象。通过调查问卷、个人访谈及相关检查数据的收集, 分析农村慢阻肺患者的疾病特征、就医模式以及影响早期诊断和规范化治疗的因素。结果 在确诊为慢阻肺而纳入研究的343 例患者中, 既往有明显症状而反复就诊者118 例, 症状持续时间5 ～10 年者62% , 10 年以上者19% , 其中仅2 例此前被诊断为慢阻肺（ 2% ） , 15 例（ 13% ） 诊断为慢支炎、肺气肿, 仅1 例（ 1% ） 接受肺功能检查。在治疗过程中抗生素使用比例高达93% , 茶碱58% , 吸入糖皮质激素＋ 长效β2 受体激动剂（ ICS ＋LABA） 4% 。尽管96% 的患者希望接受有关慢阻肺的健康宣教, 但74% 的患者却不愿定期医院复诊随访病情。结论 农村人群的健康意识、行为模式和基层医院慢阻肺防控能力薄弱是农村慢阻肺患病率高、诊断延迟和规范化治疗缺失的重要原因。

Current Situation of Diagnosis and Treatment of COPD in Western Rural Area of China

Objective To evaluate the disease characteristics, medical consultation model andbarrier to get basic medical service rural patients with chronic obstructive pulmonary disease（ COPD） inChinese western.Methods The subjects were collected from a COPD epidemiology study conducted inWestern rural district. The factors which were associated with disease characteristics, medical consultationmodel, and barrier to get basic medical service were analyzed by questionnaire, individual conversation, andlaboratory tests.Results This study enrolled 343 COPD patients confirmed by spirometry test. 118 subjectsconsulted their doctors frequently because of apparent symptom. 73（ 62% ） subjects had symptom with 5 to10 years, while 22（ 19% ） subjects with more than 10 years. Among the symptomatic COPD subjects, only 2（ 2% ） cases were diagnosed as COPD previously, 15（ 13% ） subjects with chronic bronchitis, and only 1（ 1% ） subject underwent spirometry test. 110 （ 93% ） subjects were prescribed as antibiotics, 68 （ 58% ）subjects with theophylline, 5 （ 4% ） subjects with ICS ＋ LABA. COPD education was acceptable in mostsubjects（ 98% ） , however, the regular follow-up was acceptable in only 26% of subjects.Conclusion Lackof disease information, inappropriate medical consultation model, and irregular COPD management in primarycare are the major factors which influence diagnosis and treatment of COPD inWestern rural area of China.