基层医院慢性阻塞性肺疾病分级管理模式构建与效果评价:一项多中心研究

doi:10.3969/j.issn.1004-583X.2026.08.003

临床荟萃 ›› 2026, Vol. 41 ›› Issue (8): 690-694.doi: 10.3969/j.issn.1004-583X.2026.08.003

基层医院慢性阻塞性肺疾病分级管理模式构建与效果评价:一项多中心研究

姚瑜¹, 叶爱秋¹, 逢建², 李夏川³, 丁月红⁴, 由振华^5a, 黄锦宏^5a, 陈良云^5b()

¹ 常熟市海虞中心卫生院内科, 江苏常熟 215500
² 常熟市中医院/常熟市新区医院呼吸与危重症医学科, 江苏常熟 215500
³ 常熟市东南街道社区卫生服务中心内科, 江苏常熟 215500
⁴ 常熟市常福街道社区卫生服务中心内科, 江苏常熟 215500
⁵ 南通大学附属常熟医院 a.呼吸与危重症医学科; b.感染性疾病科, 江苏常熟 215500

收稿日期:2026-05-20 出版日期:2026-08-20 发布日期:2026-08-25
通讯作者: 陈良云 E-mail:283930473@qq.com
基金资助:
苏州市重大疾病多中心临床研究项目——基于机器学习算法的良恶性胸腔积液新型鉴别诊断标志物的挖掘与评价:一项多中心(一项多中心);前瞻性队列研究(DZXYJ202416)

Construction and evaluation of a hierarchical management model for chronic obstructive pulmonary disease in primary hospitals: A multicenter study

Yao Yu¹, Ye Aiqiu¹, Feng Jian², Li Xiachuan³, Ding Yuehong⁴, You Zhenhua^5a, Huang Jinhong^5a, Chen Liangyun^5b()

¹ Department of Internal Medicine, Haiyu Central Health Center, Changshu 215500, China
² Department of Pulmonary and Critical Care Medicine, Changshu Hospital of Chinese Medicine/Changshu New District Hospital, Changshu 215500, China
³ Department of Internal Medicine, Southeast Street Community Health Service Center, Changshu 215500, China
⁴ Department of Internal Medicine, Changfu Street Community Health Service Center, Changshu 215500, China
⁵ a. Department of Pulmonary and Critical Care Medicine; b. Department of Infectious Diseases, Affiliated Changshu Hospital of Nantong University, Changshu 215500, China

Received:2026-05-20 Online:2026-08-20 Published:2026-08-25
Contact: Chen Liangyun E-mail:283930473@qq.com

摘要/Abstract

摘要：

目的构建适用于基层医院的慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)分级管理模式,并评价其对患者急性加重风险、肺功能及生活质量的影响。方法选取2023年1月-2025年1月在3家基层医院确诊的COPD稳定期患者120例,分为对照组(常规管理)和干预组(分级管理),随访12个月,比较两组年急性加重次数、肺功能指标、COPD评估测试评分。结果最终112例完成随访,其中干预组57例,对照组55例。干预12个月后,干预组年急性加重次数显著低于对照组[2(1, 2)次 vs 2(2, 3)次, P=0.016];干预组第一秒用力呼气容积占预计值百分比较对照组明显改善[64(63, 66)% vs 61(58, 63)%, P=0.001];干预组COPD评估测试评分下降幅度亦显著大于对照组[9(8, 10) vs 12(9, 14), P=0.001]。结论基层医院实施COPD分级管理模式可有效改善患者临床结局,具有潜在的推广价值。

关键词: 肺疾病, 慢性阻塞性, 基层医院, 分级管理, 行为教育, 肺功能

Abstract:

Objective To construct a hierarchical management model for chronic obstructive pulmonary disease (COPD) suitable for primary hospitals and to evaluate its effects on the risk of acute exacerbation, lung function, and quality of life in patients. Methods A total of 120 patients with stable COPD diagnosed in 3 primary hospitals between January 2023 and January 2025 were enrolled and assigned to a control group (routine management) and an intervention group (hierarchical management). After 12 months of follow-up, the annual number of acute exacerbations, pulmonary function indices, and COPD Assessment Test (CAT) scores were compared between the two groups. Results A total of 112 patients completed the follow-up, including 57 in the intervention group and 55 in the control group. After 12 months of intervention, the annual number of acute exacerbations was significantly lower in the intervention group than in the control group (2[1, 2] vs 2[2, 3], P=0.016). The percentage of predicted forced expiratory volume in the first second (FEV₁%) was significantly improved in the intervention group compared with the control group (64[63, 66]% vs 61[58, 63]%, P=0.001). The reduction in CAT score was also significantly greater in the intervention group than in the control group (9[8, 10] vs 12[9, 14], P=0.001).Conclusion Implementation of a hierarchical management model for COPD in primary hospitals can effectively improve clinical outcomes and has potential for broader application.

Key words: pulmonary disease, chronic obstructive, primary hospitals, hierarchical management, behavioral education, pulmonary function

中图分类号:

R563.9

姚瑜, 叶爱秋, 逢建, 李夏川, 丁月红, 由振华, 黄锦宏, 陈良云. 基层医院慢性阻塞性肺疾病分级管理模式构建与效果评价:一项多中心研究[J]. 临床荟萃, 2026, 41(8): 690-694.

Yao Yu, Ye Aiqiu, Feng Jian, Li Xiachuan, Ding Yuehong, You Zhenhua, Huang Jinhong, Chen Liangyun. Construction and evaluation of a hierarchical management model for chronic obstructive pulmonary disease in primary hospitals: A multicenter study[J]. Clinical Focus, 2026, 41(8): 690-694.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.08.003

https://www.lchc.cn/CN/Y2026/V41/I8/690

图/表 3

参考文献 25

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患者	GOLD分级	管理要点
一级(轻度)	1级	基础治疗+健康宣教
二级(中度)	2级	加强随访+行为干预
三级(重度)	3~4级	强化管理+转诊机制

患者	GOLD分级	管理要点
一级(轻度)	1级	基础治疗+健康宣教
二级(中度)	2级	加强随访+行为干预
三级(重度)	3~4级	强化管理+转诊机制

组别	例数		性别[例(%)]				年龄 (岁)	BMI(kg/m²)					高血压病[例(%)]
组别	例数		男		女		年龄 (岁)	<18.5	18.5≤BMI<24		≥24		是		否
干预组	57		34(59.6)		23(40.4)		60.0±11.3	2(3.5)	30(52.6)		25(43.9)		18(31.6)		39(68.4)
对照组	55		36(65.5)		19(34.5)		61.0±11.7	0(0)	26(47.3)		29(52.7)		18(32.7)		37(67.3)
统计值			χ²=0.403				t=-0.503	χ²=2.179					χ²=0.017
P值			0.526				0.616	0.345					0.896
组别		糖尿病[例(%)]				吸烟史[例(%)]				病程 (年)		FEV₁%初始值 (%)		CAT评分初始值
组别		是		否		是		否		病程 (年)		FEV₁%初始值 (%)		CAT评分初始值
干预组		4(7.0)		53(93.0)		26(45.6)		31(54.4)		3(2, 6)		63(59, 66)		14(12, 15)
对照组		6(10.9)		49(89.1)		28(50.9)		27(49.1)		5(3, 7)		65(62, 66)		12(9, 17)
统计值		χ²=0.524				χ²=0.314				Z=-1.467		Z=-0.982		Z=-1.723
P值		0.469				0.575				0.142		0.326		0.085

组别	例数		性别[例(%)]				年龄 (岁)	BMI(kg/m²)					高血压病[例(%)]
组别	例数		男		女		年龄 (岁)	<18.5	18.5≤BMI<24		≥24		是		否
干预组	57		34(59.6)		23(40.4)		60.0±11.3	2(3.5)	30(52.6)		25(43.9)		18(31.6)		39(68.4)
对照组	55		36(65.5)		19(34.5)		61.0±11.7	0(0)	26(47.3)		29(52.7)		18(32.7)		37(67.3)
统计值			χ²=0.403				t=-0.503	χ²=2.179					χ²=0.017
P值			0.526				0.616	0.345					0.896
组别		糖尿病[例(%)]				吸烟史[例(%)]				病程 (年)		FEV₁%初始值 (%)		CAT评分初始值
组别		是		否		是		否		病程 (年)		FEV₁%初始值 (%)		CAT评分初始值
干预组		4(7.0)		53(93.0)		26(45.6)		31(54.4)		3(2, 6)		63(59, 66)		14(12, 15)
对照组		6(10.9)		49(89.1)		28(50.9)		27(49.1)		5(3, 7)		65(62, 66)		12(9, 17)
统计值		χ²=0.524				χ²=0.314				Z=-1.467		Z=-0.982		Z=-1.723
P值		0.469				0.575				0.142		0.326		0.085

基层医院慢性阻塞性肺疾病分级管理模式构建与效果评价:一项多中心研究

Construction and evaluation of a hierarchical management model for chronic obstructive pulmonary disease in primary hospitals: A multicenter study

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参考文献 25

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组别	例数	年急性加重次数 (次)	FEV₁%终末值 (%)	CAT评分终末值
干预组	57	2(1, 2)	64(63, 66)	9(8, 10)
对照组	55	2(2, 3)	61(58, 63)	12(9, 14)
统计值		Z=-2.401	Z=-5.122	Z=-4.055
P值		0.016	0.001	0.001

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