关键词: 肺疾病, 慢性阻塞性, 肺心病, 患者分级医疗, 社区保健护理

Abstract:

Objective: To explore the impact of a detailed phased nursing model based on disease severity grading combined with integrated medical and elderly care on cardiopulmonary function and acute exacerbation risk in community patients with chronic obstructive pulmonary disease (COPD) complicated by cor pulmonale, providing a basis for long-term community nursing management of this elderly patient population. Methods: Sixty patients with COPD and cor pulmonale who were diagnosed through pulmonary function screening of permanent residents in Xiayang Subdistrict Community Health Service Center, Shanghai, from January to December 2024 and included in the community chronic disease management program were selected as study subjects. They were randomly divided into a control group and an observation group (30 cases for each). The control group received routine chronic disease nursing interventions in the community, while the observation group was provided with detailed phased nursing care based on disease severity grading and integrated medical and elderly care. Their post-intervention pulmonary function indicators, cardiac function indicators, and acute exacerbation frequencies within 6 months were compared between the two groups. Results: Before intervention, the control group’s average predicted percentage of forced expiratory volume in one second, forced vital capacity, N-terminal pro-brain natriuretic peptide, and 6-minute walking distance were (47.89±6.72) %, (1.91±0.35) L, (720.14±106.32) pg/ml, and (253.47±39.15) m, respectively, with no statistically significant differences compared to the observation group((48.12±6.58) %, (1.93±0.32) L, (717.36±102.85) pg/ml, and (255.12±38.64) m; t=0.217, P=0.829; t=0.184, P=0.855; t=0.125, P=0.901; t=0.196, P=0.845). After the intervention, the observation group showed an average first-second forced expiratory volume as a percentage of the predicted value of (56.23±7.91) % and an average forced vital capacity of (2.47±0.42) L, both higher than those of the control group ((48.26±6.85) % and (1.94±0.33) L, respectively). The observation group had an average N-terminal pro-brain natriuretic peptide level of (481.95±90.87) pg/ml, lower than the control group’s (715.82±104.96) pg/ml. Their average 6-minute walking distance was (324.85±43.76) m, longer than the control group’s (256.93±38.42) m. Their average number of acute exacerbations was (1.05±0.45), fewer than the control group’s (2.41±0.80). All differences were statistically significant (t=7.632, P<0.001; t=5.196, P<0.001; t=9.380, P<0.001; t=6.305, P<0.001; t=7.938, P<0.001). Conclusion: For community patients with COPD combined with cor pulmonale, the detailed phased nursing model based on disease severity grading combined with a medical-elderly care integration approach can effectively improve cardiopulmonary function and reduce the risk of acute exacerbations, demonstrating practical value for application in grassroots level.

Key words: Pulmonary disease, chronic obstructive, Pulmonary heart disease, Progressive patient care, Community health nursing