汶川大地震后灾区慢性阻塞性肺疾病患者急性加重的主要危险因素分析
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摘要
目的研究汶川地震后灾区慢性阻塞性肺疾病(COPD)患者急性加重的主要危险因素以及地震对COPD患者心理状况的影响,为重大自然灾害后COPD急性加重的防治提供依据。方法采用病例对照研究。在地震后12个月内,使用地震后慢性阻塞性肺疾病急性加重(AECOPD)患者主要诱发因素和危险因素调查问卷等5类问卷,对301例来自四川地震灾区(灾区组)及非灾区(对照组)的COPD患者进行问卷调查并进行相应的统计分析。结果总计269例COPD患者完成本次调查随访,其中灾区组133例,对照组136例。①灾区组在随访3个月和12个月内急性加重次数均高于对照组(P<0.05)。②灾区组在12个月随访时呼吸困难评分(mMRC)高于对照组(P<0.05)。③灾区组在入组和3个月随访时创伤后应激障碍(PTSD)的阳性率及焦虑自评量表(SAS)、抑郁自评量表(SDS)评分高于对照组(P<0.05);12个月随访时,除PTSD阳性率(P=0.001)外,两组SAS、SDS评分差异无统计学意义(P>0.05)。④入组时灾区组和对照组的PTSD阳性率及SAS、SDS评分与3个月随访时比较差异无统计学意义(P>0.05);与入组时相比较,第12个月随访时灾区组PTSD阳性率、SAS及SDS评分好转,对照组PTSD阳性率亦下降(P<0.01)。⑤灾区组和对照组的居住环境在3个月随访时差异明显(P<0.001);与3个月随访时相比较,12个月随访时两组的居住环境均有明显改善(P<0.001)。⑥二分类logistic回归分析显示老年(OR=2.571,P=0.023)、肺功能损害程度较重(OR=2.915,P=0.003)、心理障碍(OR=5.978,P=0.003)、居住环境恶劣(OR=3.167,P=0.010)可能是灾后灾区COPD患者急性加重的危险因素。结论地震给灾区COPD患者造成了较大的心理创伤,老年、肺功能损害程度较重、心理障碍、居住环境恶劣可能是灾后COPD患者发生急性加重的危险因素。灾后有必要尽早对COPD患者采取及时有效的心理干预及尽早改善其居住环境。
Objective To investigate the major risk factors for acute exacerbations of chronic obstructive pulmonary disease(COPD) and the role of mental status in patients who survived the Wenchuan Earthquake.Methods A questionnaire survey was conducted in 301 COPD patients from the earthquake and non-earthquake areas in Sichuan one month,three months and 12 months after the Wenchuan Earthquake.Results A total of 269 patients with COPD completed this study,which included 133 patients earthquake area and 136 from non-earthquake area.① Patients from earthquake area had significant higher incidence of acute exacerbations of COPD than those from non-earthquake area 3 months(0.57±0.688 vs.0.40±0.601) and 12 months(1.82±1.375 vs.1.47±1.366) after the earthquake.② Patients from earthquake area had significant higher Modified British Medical Research Council(mMRC) grades of COPD than those from non-earthquake area 12 months(P<0.05) after the earthquake.③Patients from earthquake area had significant higher prevalence of posttraumatic stress disorder(PTSD) and higher scores of Self-Rating Anxiety Scale(SAS) and Self-Rating Depression Scale(SDS) than those from non-earthquake area within one month and 3 months after the earthquake.The difference in PTSD prevalence rema ined significant 12 months after the earthquake.④ No significant differences i n the prevalence of PTSD and the scores of SAS and SDS were found within one mon th and 3 months after the earthquake,though significant improvements were obser ved 12 months after the earthquake for both participants from the earthquake and non-earthquake areas(P< 0.01).⑤ Patients from earthquake area lived in worse environment than those from non-earthquake area during the first 3 months after the earthquake(P< 0.001).The living environments of both groups imp roved significantly 12 months later(P< 0.001).⑥ Binary logistic regressio n showed that older age,worse pulmonary function,psychological disorder,worse living environment were risk factors of acute exacerbation of COPD after the We nchuan Earthquake.ConclusionThe earthquake caused serious psy chological trauma in COPD patients.Older age,worse pulmonary function,psychol ogical disorder,worse living environment are risk factors associated with acute exacerbation of COPD.COPD patients should receive psychotherapy and better liv ing arrangement as early as possible after serious disasters.
Objective To investigate the major risk factors for acute exacerbations of chronic obstructive pulmonary disease(COPD) and the role of mental status in patients who survived the Wenchuan Earthquake.Methods A questionnaire survey was conducted in 301 COPD patients from the earthquake and non-earthquake areas in Sichuan one month,three months and 12 months after the Wenchuan Earthquake.Results A total of 269 patients with COPD completed this study,which included 133 patients earthquake area and 136 from non-earthquake area.① Patients from earthquake area had significant higher incidence of acute exacerbations of COPD than those from non-earthquake area 3 months(0.57±0.688 vs.0.40±0.601) and 12 months(1.82±1.375 vs.1.47±1.366) after the earthquake.② Patients from earthquake area had significant higher Modified British Medical Research Council(mMRC) grades of COPD than those from non-earthquake area 12 months(P<0.05) after the earthquake.③Patients from earthquake area had significant higher prevalence of posttraumatic stress disorder(PTSD) and higher scores of Self-Rating Anxiety Scale(SAS) and Self-Rating Depression Scale(SDS) than those from non-earthquake area within one month and 3 months after the earthquake.The difference in PTSD prevalence rema ined significant 12 months after the earthquake.④ No significant differences i n the prevalence of PTSD and the scores of SAS and SDS were found within one mon th and 3 months after the earthquake,though significant improvements were obser ved 12 months after the earthquake for both participants from the earthquake and non-earthquake areas(P< 0.01).⑤ Patients from earthquake area lived in worse environment than those from non-earthquake area during the first 3 months after the earthquake(P< 0.001).The living environments of both groups imp roved significantly 12 months later(P< 0.001).⑥ Binary logistic regressio n showed that older age,worse pulmonary function,psychological disorder,worse living environment were risk factors of acute exacerbation of COPD after the We nchuan Earthquake.ConclusionThe earthquake caused serious psy chological trauma in COPD patients.Older age,worse pulmonary function,psychol ogical disorder,worse living environment are risk factors associated with acute exacerbation of COPD.COPD patients should receive psychotherapy and better liv ing arrangement as early as possible after serious disasters.
引文
1 Chan EY,Sondorp E.Medical interventions following naturaldisasters:missing out on chronic medical needs.Asia Pac JPublic Health,2007;19Spec No:45-51.
2 Sharma AJ,Weiss EC,Young SL,et al.Chronic disease andrelated conditions at emergency treatment facilities in the NewOrleans area after Hurricane Katrina.Disaster Med PublicHealth Prep,2008;2(1):27-32.
3中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华内科杂志,2007;46(3):254-261.
4彭敏,蔡柏蔷.美国胸科协会和欧洲呼吸协会对慢性阻塞性肺疾病.中华内科杂志,2005;44(5):394-397.
5 American psychiatric association.Diagnostic and statisticalmanual of menial disorders.ⅣEdition.Washington DC:Author,1994:427-429.
6孙学礼主编.精神病学.第1版.北京:高等教育出版社,2005:59-60.
7陈祥慧,冯琼华,吴景芬等.5.12汶川大地震127例伤员心理健康状况分析.实用医学临床杂志,2009;6(1):45-46.
8桥东平,陈丽等.重建期震区居民心理状况与心理援助.华中师范大学学报(人文社会科学版),2011;50(1):154-160.
9张本,张凤阁,王丽萍等.30年后唐山地震所致孤儿创伤后应激障碍现患率调查.中国心理卫生杂志,2008;22(6):469-473.
10赵高峰,杨彦春,张树森等.汶川地震灾区780名受灾群众心理状况调查.中国循证医学杂志,2008;8(10):815-819.
11郭阳,陈爱敏,林浩春等.“5.12”汶川大地震伤员应激状况调查.南方医科大学学报,2008;28(7):1114-1116,1122.
12孙伟伟,叶兰仙,张玉堂等.玉树地震后受伤灾民心理状况及影响因素分析.广东医学,2011;32(6):785-787.
13温盛霖,王相兰,陶炯.四川江油太平镇安置点北川、平武地震灾区群众1周后心理症状分析.中国神经精神疾病杂志,2008;34(9):525-527.
14蔡闯,钟南山.慢性阻塞性肺疾病与焦虑抑郁的关系.中华结核和呼吸杂志,2007;30(1):71-72.
15高雪屏,罗兴伟.汶川地震后1月内脱离/未脱离震区的亲历者PTSD筛查阳性的发生及心理影响因素.中南大学学报(医学版),2009;34(6):504-509.
16丁薇,郑涌.创伤与创伤后的应激障碍.中国临床康复,2008;18(10):145-148.
17 Dahlen I,Janson C.Anxiety and depression are related to theoutcome of emergency treatment in patients with obstructivepulmonary disease.Chest,2002;122(5):1633-1637.
18 Yohannes AM,Baldwin RC,Connolly MJ.Depression andanxiety in elderly outpatients with chronic obstructivepulmonary disease:prevalence,and validation of the BASDECscreening questionnaire.Int J Geriatr Psychiatry,2000;15(12):1090-1096.
19 Gudmundsson G,Gislason T,Janson C,et al.Risk factors forrehospitalisation in COPD:role of health status,anxiety anddepression.Eur Respir J,2005;26(3):414-419.
20 Ng TP,Niti M,Tan WC,et al.Depressive symptoms andchronic obstructive pulmonary disease:effect on mortality,hospital readmission,symptom burden,functional status,andquality of life.Arch Intern Med,2007;167(1):60-67.
21刘宏炜,严谨,叶茂松等.慢性阻塞性肺疾病急性加重与大气中可吸入颗粒物的相关性研究.中华结核和呼吸杂志,2009;32(10):771-772.
22刘宏伟,叶伶.慢性阻塞性肺疾病急性加重与环境因素的相关性研究.上海预防医学杂志,2010;22(4):210-213.
23 Hurst JR,Vestbo J,Anzueto A,et al.Susceptibility toexacerbation in chronic obstructive pulmonary disease.N EnglJ Med,2010;363(12):1128-1138.
2 Sharma AJ,Weiss EC,Young SL,et al.Chronic disease andrelated conditions at emergency treatment facilities in the NewOrleans area after Hurricane Katrina.Disaster Med PublicHealth Prep,2008;2(1):27-32.
3中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华内科杂志,2007;46(3):254-261.
4彭敏,蔡柏蔷.美国胸科协会和欧洲呼吸协会对慢性阻塞性肺疾病.中华内科杂志,2005;44(5):394-397.
5 American psychiatric association.Diagnostic and statisticalmanual of menial disorders.ⅣEdition.Washington DC:Author,1994:427-429.
6孙学礼主编.精神病学.第1版.北京:高等教育出版社,2005:59-60.
7陈祥慧,冯琼华,吴景芬等.5.12汶川大地震127例伤员心理健康状况分析.实用医学临床杂志,2009;6(1):45-46.
8桥东平,陈丽等.重建期震区居民心理状况与心理援助.华中师范大学学报(人文社会科学版),2011;50(1):154-160.
9张本,张凤阁,王丽萍等.30年后唐山地震所致孤儿创伤后应激障碍现患率调查.中国心理卫生杂志,2008;22(6):469-473.
10赵高峰,杨彦春,张树森等.汶川地震灾区780名受灾群众心理状况调查.中国循证医学杂志,2008;8(10):815-819.
11郭阳,陈爱敏,林浩春等.“5.12”汶川大地震伤员应激状况调查.南方医科大学学报,2008;28(7):1114-1116,1122.
12孙伟伟,叶兰仙,张玉堂等.玉树地震后受伤灾民心理状况及影响因素分析.广东医学,2011;32(6):785-787.
13温盛霖,王相兰,陶炯.四川江油太平镇安置点北川、平武地震灾区群众1周后心理症状分析.中国神经精神疾病杂志,2008;34(9):525-527.
14蔡闯,钟南山.慢性阻塞性肺疾病与焦虑抑郁的关系.中华结核和呼吸杂志,2007;30(1):71-72.
15高雪屏,罗兴伟.汶川地震后1月内脱离/未脱离震区的亲历者PTSD筛查阳性的发生及心理影响因素.中南大学学报(医学版),2009;34(6):504-509.
16丁薇,郑涌.创伤与创伤后的应激障碍.中国临床康复,2008;18(10):145-148.
17 Dahlen I,Janson C.Anxiety and depression are related to theoutcome of emergency treatment in patients with obstructivepulmonary disease.Chest,2002;122(5):1633-1637.
18 Yohannes AM,Baldwin RC,Connolly MJ.Depression andanxiety in elderly outpatients with chronic obstructivepulmonary disease:prevalence,and validation of the BASDECscreening questionnaire.Int J Geriatr Psychiatry,2000;15(12):1090-1096.
19 Gudmundsson G,Gislason T,Janson C,et al.Risk factors forrehospitalisation in COPD:role of health status,anxiety anddepression.Eur Respir J,2005;26(3):414-419.
20 Ng TP,Niti M,Tan WC,et al.Depressive symptoms andchronic obstructive pulmonary disease:effect on mortality,hospital readmission,symptom burden,functional status,andquality of life.Arch Intern Med,2007;167(1):60-67.
21刘宏炜,严谨,叶茂松等.慢性阻塞性肺疾病急性加重与大气中可吸入颗粒物的相关性研究.中华结核和呼吸杂志,2009;32(10):771-772.
22刘宏伟,叶伶.慢性阻塞性肺疾病急性加重与环境因素的相关性研究.上海预防医学杂志,2010;22(4):210-213.
23 Hurst JR,Vestbo J,Anzueto A,et al.Susceptibility toexacerbation in chronic obstructive pulmonary disease.N EnglJ Med,2010;363(12):1128-1138.
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