| 摘要: | 目的：慢性阻塞性肺病是常見的慢性疾病之一，占全球第五位主要死因，研究者以慢性阻塞性肺病病人為對象，探討慢性阻塞性肺病病人介入自我管理計畫與其疾病嚴重度之相關性，進而建構影響慢性阻塞性肺病人疾病嚴重度預測模式，做為將來介入處置的參考依據。
方法：本研究為回溯性世代研究法，研究對象為台灣南部某醫學中心慢性阻塞性肺病病人，於2017年1月至2018年12月之門診收案病人，有效樣本資料共883人次。利用SPSS 20.0統計分析，包含描述性統計以次數分配、百分比、平均數和標準差等，推論性統計以卡方檢定和廣義估計方程式等。
結果：顯示阻塞性肺病病人平均年齡約72.8歲，以男性居多，86.6%的病人有吸菸(含已戒)的經驗，菸齡平均為39年，具共病症者占69.1%，自我管理計畫平均介入為2.76項次，就醫追蹤天數平均為148.6天，病人疾病嚴重度以Group B居多占44.7%。以卡方檢定追蹤天數與疾病嚴重度的急性發作、日常生活影響有統計上顯著不同；自我管理計畫介入總項次與疾病嚴重度的急性發作、呼吸困難及日常生活影響皆有統計上顯著不同。再利用廣義估計方程式分析，自我管理計畫介入總項次較多者會顯著減少對日常生活影響程度；隨追蹤天數顯著減少Group嚴重度，但病人急性發作、自覺呼吸困難和日常生活影響程度則顯著增加Group嚴重度。
結論：慢性阻塞性肺病病人Group嚴重度會隨年齡增長而更嚴重，但在70-80歲的病人會較小於60歲急性發作就醫顯著減少，具共病症者則顯著增加急性發作，在目前高齡化社會，建議對70-80歲的病人可積極介入自我管理計畫並持續追蹤就醫狀況，對共病症病人進行整合性門診以達病況的穩定控制，以降低惡化和延緩疾病進展。本研究亦依據研究提出相關政策與管理建議，以供後續各界參考之用。
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases, accounting for the fifth leading cause of death in the world. The research purpose is to explore the relationship between the interventional self-management plan and the disease severity in patients with COPD and build a statistical prediction model for further clinical care refernces.
METHODS: A retrospective cohort study was adopted with sample source from patients with COPD at a medical center in southern Taiwan. Participants were enrolled from those who admitted from the outpatient clinic from January 2017 to December 2018. A total of 883 valid samples was used for further statistic analysis. With the package software SPSS 20.0, statistical methods were used including descriptive statistics by the description of data distribution, percentage, mean and standard deviation, etc., inferential statistics by chi-square and generalized estimation equations.
RESULTS: The mean age of patients with COPD was about 72.8 years old, mostly male. 86.6% of the patients had smoking history (including quit) with an average of 39 smoking years. 69.1% of patients were labed comorbidities accounted. The average the interventional self-management plan was 2.76 treatments, the average number of medical traces was 148.6 days, and the patient's disease severity was 44.7% of Group B. There were statistically significances in the acute onset and daily life effects of the chi-square test tracking days and the severity of the disease; the total incidence of self-management planning and the severity of the disease severity, dyspnea and daily life were statistically significant different. Using the generalized estimating equation analysis, the total number of interventions in the self-management plan can significantly reduce the impact on daily life; the group severity will be significantly reduced with the number of days of tracking, but the patient's acute attack, conscious breathing difficulties and daily life impact will be significantly increase Group severity.
Conclusion: Group severity of patients with COPD will be more severe with age, but in 70-80 years old patients will be significantly less than 60 years old acute attacks, and patients with comorbidities will significantly increase acute attacks. In an aging society, it is recommended that patients aged 70-80 can actively participate in self-management plan and continue to track medical conditions, and integrate outpatients with comorbid conditions to achieve stable control of disease conditions to reduce deterioration and delay disease progression. Finally, we provide several suggestions for further research and policy making. |
