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目的研究外科手术前患者慢性阻塞性肺疾病(COPD)的患病率、漏诊率以及与高危因素的关系。方法选择2007年11月至12月在复旦大学附属中山医院准备行胸腹部非急诊手术的339例患者,所有患者经肺功能室检查,记录并分析其一般情况、暴露史和肺功能检查结果。结果COPD的患病率21.8%,漏诊率83.8%。53.1%暴露史阳性,吸烟和职业暴露分别为43.1%和18.6%;两类暴露人群的患病率分别为34.2%和36.5%。暴露史阴性受检者的患病率为8.8%,漏诊率为71.4%。在50岁以上的受检者中,暴露史阳性和阴性的患病率分别为38.0%和10.0%。男性患病率为25.1%,高于女性的15.2%(P=0.04),但Logistic回归分析显示患病率同性别无关(OR=0.80,95%CI:0.42～1.51),同暴露史有关(OR=4.22,95%CI:2.35～8.34)。肺癌和非肺癌患者COPD的患病率相似。新检出的的COPD漏诊者中,Ⅰ级30.6%,Ⅱ级56.5%,Ⅲ级11.3%,Ⅳ级1.9%。结论外科患者多数有吸烟和职业暴露等COPD高危因素,长期职业暴露所占比重较大。COPD的患病率高,漏诊现象严重,且病情多已达到或超过中度水平。
Objective To investigate the prevalence, misdiagnosis rate of chronic obstructive pulmonary disease (COPD) in patients before surgery and its relationship with risk factors. Methods From November 2007 to December 2007, 339 patients undergoing non-emergency thoracic and abdominal surgery at Zhongshan Hospital Affiliated to Fudan University were enrolled. All patients were examined by pulmonary function room and the general situation, exposure history and pulmonary function test results were recorded and analyzed. Results The prevalence of COPD was 21.8% and the rate of missed diagnosis was 83.8%. 53.1% had a positive history of exposure with smoking and occupational exposure of 43.1% and 18.6% respectively; the prevalence rates of the two groups were 34.2% and 36.5% respectively. The prevalence of subjects with negative exposure history was 8.8% and the missed diagnosis rate was 71.4%. Among subjects over the age of 50, the prevalence of positive and negative exposure was 38.0% and 10.0%, respectively. The prevalence was 25.1% in males and 15.2% in females (P = 0.04), but the logistic regression analysis showed that the prevalence was unrelated to the same sex (OR = 0.80, 95% CI: 0.42 to 1.51) OR = 4.22, 95% CI: 2.35 ~ 8.34). The prevalence of COPD was similar in lung and non-lung cancer patients. Among the newly diagnosed patients with COPD, grade Ⅰ was 30.6%, grade Ⅱ 56.5%, grade Ⅲ 11.3% and grade Ⅳ 1.9%. Conclusion Most of the surgical patients have risk factors of COPD, such as smoking and occupational exposure, and the proportion of long-term occupational exposure is larger. The prevalence of COPD, missed diagnosis is serious, and the condition has reached or exceeded the moderate level.