慢性阻塞性肺疾病症状群及其与患者生活质量的相关性研究

doi:10.19983/j.issn.2096-8493.2024067

摘要/Abstract

摘要：

目的: 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者不同时期症状群的组成、症状群之间的相互关系及症状群对患者生活质量的影响。方法: 采用便利抽样方法选取2022年11月至2023年11月在宁波大学附属人民医院呼吸与危急症医学科住院的223例COPD患者,应用患者基本资料调查表、症状评定量表(memorial symptom assessment scale,MSAS)、COPD评估测试量表(COPD assessment test,CAT)评估患者在疾病加重住院第1天(T₁)、出院前1天或当天(T₂)和出院后1个月疾病稳定期(T₃)、出院后3个月疾病稳定期(T₄)的症状、呼吸困难、情绪等情况,应用统计描述、因子分析和聚类分析等方法对症状进行分析,及评估症状群对患者生活质量的影响。结果: T₁至T₄期间 COPD患者症状数分别为29(26,31)个、25(22,28)个、27(25,29)个、29(27,31)个。4个时间点有3个不同的症状群:呼吸系统-感知相关症状群、心理-感知相关症状群和胃肠道-感知相关症状群。T₁至T₄期间COPD患者CAT量表总分分别为(29.13±6.37)分、(20.31±6.47)分、(18.68±6.27)分、(20.31±6.47)分,不同时间点CAT量表总分经方差分析,差异有统计学意义(F=126.284,P<0.001)。3个症状群与患者生活质量相关性分析,除T₄胃肠道-感知相关症状群与CAT总分没有相关性(r=0.009,P>0.05),其他均与CAT总分呈正相关(P值均<0.05)。结论: COPD患者在疾病的急性发作期及稳定期经历不同的症状体验,症状群以3种形式出现,症状加重,对患者的困扰越严重,对其生活质量的影响也越大。

关键词: 肺疾病, 阻塞性, 体征和症状, 生活质量

Abstract:

Objective: To explore the composition of symptom groups at different stages of chronic obstructive pulmonary disease (COPD) patients, the interrelationships between symptom groups, and the correlation between symptom groups and patient’s quality of life. Methods: Convenience sampling was used to select 223 COPD patients who were hospitalized from November 2022 to November 2023 in Department of Respiratory and Critical Care Medicine, Ningbo University Affiliated to People’s Hospital. A patient basic information questionnaire, memorial symptom assessment scale (MSAS), and COPD assessment test (CAT) were used to evaluate symptoms, breathing difficulties, and emotions of the patients on the first day of hospitalization (T₁, disease exacerbation phase), the day before or on the day of discharge (T₂), and one month (T₃) and three months (T₄) after discharge(disease stable phase). Statistical description, factor analysis, and cluster analysis were used to analyze the symptoms and evaluate their impact on the patient’s quality of life. Results: The average numbers of symptoms in COPD patients between T₁ and T₄ were 29 (26, 31), 25 (22, 28), 27 (25, 29), and 29 (27, 31), respectively. There were three different symptom groups at four time points: respiratory perception related symptom group, psychological perception related symptom group, and gastrointestinal perception related symptom group. The average total scores of CAT scales for COPD patients between T₁ and T₄ were 29.13±6.37, 20.31±6.47, 18.68±6.27, and 20.31±6.47, respectively, variance analysis showed that the difference was statistically significant (F=126.284, P<0.001). The correlation analysis between three symptom groups and patient’s quality of life showed that except for gastrointestinal perception related symptom group at T₄ which was not correlated with the total score of CAT (r=0.009,P>0.05), all other symptom groups were positively correlated with the total score of CAT (Ps<0.05). Conclusion: COPD patients experience different symptoms during the acute and stable phases of the disease, with symptoms clustering in three forms and worsening. The more severe the distress on the patient, the greater the impact on their quality of life.

Key words: Pulmonary disease, obstructive, Signs and symptoms, Quality of life

中图分类号:

R473.5

邱巧静, 陶洋, 沈佳妮, 徐佳频, 朱丽红, 顾芬. 慢性阻塞性肺疾病症状群及其与患者生活质量的相关性研究[J]. 结核与肺部疾病杂志, 2024, 5(3): 219-224. doi: 10.19983/j.issn.2096-8493.2024067

Qiu Qiaojing, Tao Yang, Shen Jiani, Xu Jiapin, Zhu Lihong, Gu Fen. Research of symptom groups of chronic obstructive pulmonary disease and their correlation with patient’s quality of life[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(3): 219-224. doi: 10.19983/j.issn.2096-8493.2024067

图/表 2

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特征	例数	构成比(%)	特征	例数	构成比(%)
性别			医保支付方式
男性	152	68.16	农村医保	14	6.28
女性	71	31.84	城镇医保	205	91.93
年龄组(岁)			自费	4	1.79
≤60	21	9.42	体质量指数
61~80	117	52.46	过轻(≤18.4)	53	23.77
≥81	85	38.12	正常(18.5~23.9)	112	50.22
学历			过重(24~27.9)	42	18.83
小学及以下	164	73.54	肥胖(≥28)	16	7.18
初中	40	17.94	血压
高中及以上	19	8.52	正常	196	87.89
宗教信仰			异常	27	12.11
有	15	6.73	心率(次/min)
无	208	93.27	正常(60~100)	177	79.37
工作			异常(<60或>100)	46	20.63
有	40	17.94	入院方式
无	183	82.06	门诊	195	87.44
家庭人均月收入(元)			急诊	28	12.56
<1000	19	8.52	近1年内COPD加重次数
1000~3999	163	73.09	0	44	19.73
≥4000	41	18.39	1~5	160	71.75
病程(年)			≥6	19	8.52
0~4	47	21.07	因COPD入院次数(次)
5~9	97	43.50	0	22	9.87
≥10	79	35.43	1~5	185	82.96
			≥6	16	7.17

时间点	累计方差贡献率	呼吸系统-感知相关症状群
时间点	累计方差贡献率	组成	Cronbach’s α系数	组成	Cronbach’s α系数	组成	Cronbach’s α系数
T₁	40%	气短或呼吸困难、苦恼程度、睡眠不安、疲乏乏力、昏昏欲睡、没胃口、悲伤、濒死感、感觉别人觉得我脏、性功能障碍	0.824	注意力不集中、渴望有人陪伴、少尿、尿频尿急、视力模糊、头晕、便秘	0.703	呕吐、口干、恶心、麻木、疼痛、健忘	0.821
T₂	40%	气短或呼吸困难、苦恼程度、睡眠不安、疲乏乏力、昏昏欲睡、没胃口、悲伤	0.925	视力模糊、声音嘶哑、头晕、便秘、注意力不集中、少尿、尿频尿急、感觉别人觉得我脏、肿胀感	0.681	呕吐、口干、恶心、麻木、疼痛、健忘	0.942
T₃	42%	气短或呼吸困难、苦恼程度、睡眠不安、疲乏乏力、昏昏欲睡、没胃口、悲伤	0.943	感觉别人觉得我脏、肿胀感、视力模糊、声音嘶哑、头晕、少尿、尿频尿急	0.701	呕吐、口干、恶心、麻木、疼痛、健忘、腹胀	0.906
T₄	43%	气短或呼吸困难、苦恼程度、睡眠不安、疲乏乏力、昏昏欲睡、没胃口、悲伤、头晕、濒死感、腹胀	0.920	感觉别人觉得我脏、肿胀感、便秘、视力模糊、声音嘶哑、少尿、尿频尿急	0.625	呕吐、口干、恶心、麻木、疼痛、健忘	0.948