摘要目的:建立慢性阻塞性肺疾病（COPD）社区综合防治管理平台，评估其在COPD综合防治中的有效性和可行性。方法:基于信息化网络建立COPD社区综合防治管理平台，内容主要包括对COPD的筛查、建立社区 COPD 患者电子健康档案、对COPD患者进行分级管理等，对照组与研究组分别为2个环境相似社区卫生服务中心就诊的符合COPD入选标准的患者，每组1 000例，对照组社区未建立COPD社区综合防治管理平台，仅给予诊断与传统治疗；研究组社区建立COPD社区综合防治管理平台，筛查COPD、建立社区 COPD 患者电子健康档案、对COPD患者进行分级管理等。随访1年，比较两组患者COPD急性加重次数、治疗费用、肺功能改善情况、呼吸困难程度及生活质量，分析平台建立对COPD的防治效果。结果:随访1年，对照组发生COPD急性加重事件578例，研究组发生COPD急性加重事件326例。研究组发生COPD急性加重事件的比例［32.60%（326/1 000）］、急性加重次数［（1.52±0.58）次］、治疗费用［（2 014.21±122.29）元］均显著低于对照组［57.80%（578/1 000）、（2.28±2.15）次、（4 201.34±210.25）元］，两组差异均有统计学意义（ t=12.34、3.19、21.24，均 P<0.05）；管理平台建立前，两组患者肺功能、呼吸困难评分（mMRC）分级及COPD评估测试（CAT）评分差异均无统计学意义（均 P>0.05）。随访1年，对照组第一秒用力呼气量/用力呼气量（FEV 1/FVC）［（60.32±12.31）%］、FEV 1预测值［（63.65±9.37）%］、mMRC分级（1.89±1.01）、CAT评分［（18.82±5.35）分］与1年前比较，差异均无统计学意义 （ t=0.79、0.87、1.05、0.83，均 P>0.05）。研究组FEV 1/FVC［（65.27±13.59）%］、FEV 1预测值［（68.92±10.67）%］、mMRC分级（1.41±0.72）、CAT评分［（13.24±5.21）］与1年前比较，差异均有统计学意义 （ t=3.28、3.39、4.17、5.71，均 P<0.05）；管理平台建立后，两组各项指标相比，差异均有统计学意义（ t=3.61、5.48、2.93、5.68，均 P<0.05）。 结论:COPD社区综合防治管理平台在COPD综合防治中效果显著，其可有效降低急性加重频率，减少治疗费用，在改善肺功能和呼吸困难程度的同时，提高患者生活质量。

abstractsObjective:To construct a comprehensive community management platform for prevention and treatment of chronic obstructive pulmonary disease (COPD) and evaluate its effectiveness and feasibility in the prevention and treatment of COPD.Methods:A comprehensive community management platform for prevention and treatment of COPD was established based on the information network. The platform mainly includes COPD screening, establishment of electronic health files of COPD patients living in the community, and hierarchical management of COPD patients. Patients who met COPD criteria were admitted by two community health centers (control and study groups, n = 1 000/group) with similar environments. In the control group, comprehensive community management platform for prevention and treatment of COPD was not established, and only diagnosis and conventional treatment were performed. In the study group, comprehensive community management platform was established to screen COPD patients, establish electronic health files of COPD patients, and hierarchically manage the COPD patients. All patients were followed up for 1 year. The number of acute exacerbations of COPD, treatment cost, the improvement in pulmonary function, dyspnea, and quality of life were compared between the two groups. The effects of the established comprehensive community management platform on prevention and treatment of COPD were analyzed. Results:One-year follow-up results revealed that an acute exacerbation of COPD occurred in 578 patients from the control group and 326 patients from the study group. The proportion of an exacerbation of COPD, the number of exacerbations of COPD, treatment cost in the study group were 32.60% (326/1 000), (1.52 ± 0.58), (2 014.21 ± 122.29) yuan, respectively, which were significantly lower than those in the control group [57.80% (578/1 000), (2.28 ± 2.15), and (4 201.34 ± 210.25) yuan, t = 12.34, 3.19, 21.24, all P < 0.05]. Before establishment of the comprehensive community management platform, there were no significant differences in pulmonary function, modified Medical Research Council (mMRC) dyspnea score, COPD assessment test (CAT) score between the two groups (all P > 0.05). In the control group, the ratio of forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC), predicted FEV 1 value, mMRC dyspnea score, and CAT score were (60.32 ± 12.31)%, (63.65 ± 9.37)%, (1.89 ± 1.01) points, (18.82 ± 5.35) points, respectively after 1 year of treatment. There were no significant differences in these indexes between before and after 1 year of treatment ( t = 0.79, 0.87, 1.05, 0.83, all P > 0.05). In the study group, FEV 1/FVC ratio, predicted FEV 1 value, mMRC dyspnea score, and CAT score were (65.27 ± 13.59)%, (68.92 ± 10.67)%, (1.41 ± 0.72) points, (13.24 ± 5.21) points, respectively after 1 year of treatment. Significant differences in these indexes were found between before and after 1 year of treatment ( t = 3.28, 3.39, 4.17, 5.71, all P < 0.05). Conclusion:The established comprehensive community management platform is highly effective for prevention and treatment of COPD. It can effectively reduce the frequency of acute exacerbations of COPD, reduce treatment cost, improve pulmonary function, alleviate dyspnea, and improve quality of life.