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[大学生论坛]:慢阻肺错失早期诊断良机 令人堪忧

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Lvrainbow 发表于 2017-12-31 16:20:00 | 显示全部楼层 |阅读模式
慢阻肺错失早期诊断良机 令人堪忧
时间:2017-12-27 10:55来源:医师报 作者:顾宇彤 朱蕾
It is worrying that chronic obstructive pulmonary disease misses the opportunity for early diagnosis.

《柳叶刀》近期在线发表的这项英国研究,通过回顾COPD确诊前的医疗模式及合并症,判断患者是否在常规诊疗中错失了早期诊断良机。结果显示,85%的患者在确诊前5年错失了早期诊断机会。
The British study, published online in the Lancet recently, judged whether patients missed early diagnosis opportunities in conventional diagnosis and treatment through looking at medical patterns and complications before the diagnosis of COPD(chronic obstructive pulmonary disease). The results showed that 85 percent of patients missed an early diagnosis in the first five years of diagnosis.

无独有偶,我国由钟南山院士牵头,覆盖北京、天津等7个省市,入选25 627人(≥40岁)大型流行病学调查(Zhong et al. AJRCCM 2007;176:753)也显示,经肺功能检查确诊为COPD的患者中,既往经肺功能测试确诊者仅占6.5%,临床诊断者也仅有35.1%;调查显示,确诊的COPD患者中35.3%无临床症状。这说明我国大量COPD患者丧失了早期诊断和早期干预的机会。
In addition, a large epidemiological survey led by an academician in China called Zhong Nanshan, covering seven provinces and cities including Beijing and Tianjin, and selecting 25,627 people (aging over 40) (Zhong et al. AJRCCM 2007; 176:753) also showed that, among patients diagnosed with COPD by pulmonary function, only 6.5 percent of the patients had been diagnosed with pulmonary function before, and only 35.1 percent were clinically diagnosed. The survey showed that 35.3 percent of the confirmed COPD patients had no clinical symptoms. This indicates that a large number of COPD patients in China have lost the opportunity of early diagnosis and early intervention.

为何早期COPD患者易漏诊?这主要是由肺功能特点决定的。健康人肺功能代偿能力非常强大,极量运动时仅动用2/3,而心功能动用100%,即剧烈运动首先不能耐受的是心脏而不是肺;而且COPD的其他症状(如咳嗽、咳痰)无特异性或通常不存在,所以易忽视。加之社会整体对COPD重视程度不足,因此早期患者易漏诊。
Why are early COPD patients easy to miss diagnosis? This is mainly determined by the functional characteristics of the lung. In healthy people, the ability to compensate for lung function is very strong, with only two-thirds of the movement of the extreme, while the cardiac function is 100%, that is to say, the heart firstly cannot tolerate vigorous exercise rather than the lungs. And other symptoms of COPD (such as cough and expectoration) are non-specific or usually nonexistent, so they are easily overlooked. In addition, people in the society does not pay much attention to COPD, therefore, early patients are vulnerable to miss diagnosis.

肺功能检查是诊断COPD的金标准。在二甲以上医院已基本普及,但大多数社区医院还没有肺功能仪,这也是影响COPD早期诊断的因素。一旦患者因明显气急就诊时,肺功能减退常已进展到中度以上。
Pulmonary function examination is the gold standard for diagnosis of COPD. Pulmonary function has been largely popularized in general hospital of level II, but not in most community hospitals, which also affects the early diagnosis of COPD. Once the patient has been seen to be in urgent need, the pulmonary function has progressed to more than moderate.

建议对年龄≥35岁的下述人群常规进行肺通气功能筛查:有慢性咳嗽、咳痰、吸烟或长期接触其他有害气体、粉尘者;幼年反复呼吸道感染者;出生时低体重或营养不良者;有COPD家族史者。还应加强对全科医生和基层呼吸科医生规范化培训,加强社会宣传,从而提高COPD早期诊断率。
It suggests to screen the following groups of people aging 35 or older for pulmonary ventilation function: people with chronic cough, phlegm, smoking or prolonged exposure to other harmful gases and dusts; People who repeated infection of the respiratory tract in infancy; People who was malnutrition or underweight at birth; People with a family history of COPD. We should also strengthen standardized training for general practitioners and primary respiratory practitioners and strengthen social publicity so as to improve the early diagnosis rate of COPD.

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