作者：姚文杰1，许凤琴2，张洁1，沈小清1，徐萍2，李海静1

单位：

1.222061江苏省连云港市，南京医科大学康达学院第一附属医院 连云港市第一人民医院呼吸与危重症医学科　2.222061 江苏省连云港市，南京医科大学康达学院第一附属医院 连云港市第一人民医院护理部

Units：

1.Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Kangda College of Nanjing Medical University/the First People's Hospital of Lianyungang, Lianyungang 222061, China 2.Nursing Department, the First Affiliated Hospital of Kangda College of Nanjing Medical University/the First People's Hospital of Lianyungang, Lianyungang 222061, China

关键词：

慢性阻塞性肺疾病；健康信念模式；主要照顾者；健康教育；吸入剂；应用效果

Keywords：

Chronic obstructive pulmonary disease; Health belief model; Primary caregivers; Health education;Inhalation; Application effect

CLC：

R 563.9

DOI：

10.12114/j.issn.1008-5971.2021.00.143

Funds：

连云港市科协软课题研究资助项目（Lkxqt2072）

摘要：

背景　吸入剂治疗被国内外指南推荐为防治慢性阻塞性肺疾病（COPD）等呼吸道疾病的首选给药方 式，但错误使用吸入剂又会影响疾病控制效果。目前，COPD 吸入剂宣教并无固定模式，更无涉及照顾者的宣教模式。 目的　探讨基于健康信念模式（HBM）的健康教育在COPD 患者吸入剂管理中的应用效果。方法　选取2019 年6 月— 2020 年6 月在连云港市第一人民医院呼吸科就诊的COPD 患者140 例，采用简单随机法分为对照组和干预组，剔除 干预过程中的脱落病例，最终干预组纳入68 例、对照组纳入65 例。对照组患者给予常规健康教育，干预组患者及其 主要照顾者给予基于HBM 的健康教育。比较两组患者入组时及入组3、6 个月后吸入给药装置使用情况评分、肺功能 指标〔第1 秒用力呼气容积占预计值的百分比（FEV1%）和第1 秒用力呼气容积与用力肺活量比值（FEV1/FVC）〕、 急性发作/ 加重次数、Morisky 用药依从性量表（MMAS-8）评分、简明健康状况调查问卷（SF-36）评分、护理满意 度评分，入组3、6 个月后临床疗效。结果　干预组患者入组3、6 个月后吸入给药装置使用情况评分、FEV1%、FEV1 /FVC、MMAS-8 评分、SF-36 评分及护理满意度评分高于对照组，急性发作/ 加重次数≥ 2 次者所占比例低于对照组 （P ＜ 0.05）。干预组患者入组3个月后吸入给药装置使用情况评分、FEV1%、FEV1/FVC、临床治疗有效率、MMAS-8评分、 SF-36 评分及护理满意度评分高于入组时，入组6 个月后吸入给药装置使用情况评分、FEV1%、FEV1/FVC、MMAS-8 评分、SF-36 评分及护理满意度评分高于入组时和入组3 个月后（P ＜ 0.05）。结论　基于HBM 的健康教育能有效提 高COPD 患者吸入剂治疗的依从性及正确率，改善患者肺功能，减少急性发作/ 加重次数，进而提高患者的临床疗效 及生活质量，且患者的护理满意度较高。

Abstract：

Background　Inhalant therapy has been recommended as the first choice for the prevention and treatment of chronic obstructive pulmonary disease (COPD) and the other respiratory diseases by domestic and foreign guidelines, but the wrong use of inhalant will affect the effect of disease control. At present, there is no fixed mode of COPD inhalant education, let alone involving caregivers. Objective　To explore the application effect of health education based on health belief model (HBM) in inhalant management of COPD patients. Methods　A total of 140 COPD patients in the Department of Respiratory of the First People's Hospital of Lianyungang from June 2019 to June 2020 were selected as the research objects. The patients were divided into control group and intervention group in accordance with a random number table. Finally, 68 cases in the intervention group and 65 cases in the control group were included after shedding cases were eliminated. The patients in the control group were given regular health education, the patients and their primary caregivers in the intervention group were given health education based on the HBM. The score of usage of inhalation drug delivery device, pulmonary function indexes [percentage of forced expiratory volume in the first second to predicted value (FEV1%) and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ] , times of acute attack/exacerbation, Morisky Medication Adherence Scale (MMAS-8), Short Form 36 Health Survey Questionnaire (SF-36) score and nursing satisfaction score were compared between the two groups before intervention, 3 and 6 months after intervention, and clinical effect was compared between the two groups 3 and 6 months after intervention. Results　The score of usage of inhalation drug delivery device, FEV1%, FEV1/FVC, MMAS-8 score, SF-36 score and nursing satisfaction score in the intervention group were higher than those in the control group 3 and 6 months after intervention (P < 0.05) ; the proportion of patients with more than 2 times of acute attack/exacerbation in the intervention group was lower than that in the control group 3 and 6 months after intervention (P < 0.05) . In the intervention group, the score of usage of inhalation drug delivery device, FEV1%, FEV1/FVC, effective rate of treatment, MMAS-8 score, SF-36 score and nursing satisfaction score 3 months after intervention were higher than those before intervention, while above indicators 6 months after intervention were higher than those before intervention and 3 months after intervention (P < 0.05). Conclusion　Health education based on HBM can effectively improve the compliance and correct rate of COPD patients with inhalation therapy, improve the pulmonary function of patients, reduce the number of acute attack/aggravation, and then improve the clinical efficacy and quality of life of patients, and the nursing satisfaction of patients is high.

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