Objective To investigate the effect of family follow-up intervention in patients with chronic ob-structive pulmonary diseases in community. Methods 180 patients who were definitely diagnosed and hospitalized in East Hospital and Luijiazui community health service from November 2014 to July 2015 due to repeated AECOPD were selected as the research object and divided into the intervention group and the control group, 90 cases in each group, according to age, gender and severity of pulmonary function. The intervention group was given the optimal fol-low-up, while the control group was given routine follow-up. The effect of the follow-up invention between the two groups was compared. Results After the two groups were followed up, the scores of CAT, the walking test in six mi-nutes and pulmonary function were improved, but the improvement in the intervention group was more significant ( P<0. 05). The rate of hospitalization due to the COPD in the intervention group in one year was 43. 33% and the times of acute attacks were (2. 05 ± 0. 63) in one year, which were significantly lower than those in the control group (P<0. 01). Conclusion Family optimized follow-up can effectively improve the prognosis of patients with chronic obstructive pulmonary disease and can reduce the times of acute exacerbation and hospitalization rate, which is worthy of wide popularization and application.%目的 探讨社区慢性阻塞性肺病家庭随访干预效果.方法 选取2014年11月-2015年7月在上海东方医院、陆家嘴社区卫生服务中心明确诊断的因慢阻肺反复急性加重而住院的180例患者作为研究对象,按年龄、性别、肺功能严重度配对分组,每组90例.其中干预组给予家庭优化随访,对照组给予家庭常规随访,比较两组随访干预效果.结果 两组随访结束后CAT得分、六分钟步行试验、肺功能分级,均有明显改善,但干预组改善更明显(P<0.05);干预组1年内因慢阻肺再次住院率、1年内急性加重次数分别为43.33%、(2.05±0.63)次,均明显低于对照组(P<0.01).结论 对社区慢阻肺病患者给予家庭优化随访可有效改善患者预后,减少急性加重次数与再住院率,值得推广应用.
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