基层常见疾病诊疗指南
ENGLISH ABSTRACT
中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年)
中华医学会
中华医学会杂志社
中华医学会全科医学分会
中华医学会呼吸病学分会慢性阻塞性肺疾病学组
中华医学会《中华全科医师杂志》编辑委员会
中国呼吸系统疾病基层诊疗与管理指南制定专家组
作者及单位信息
·
DOI: 10.3760/cma.j.cn114798-20240326-00174
Chinese guideline for management of chronic obstructive pulmonary disease in primary care (2024)
Chinese Medical Association
Chinese Medical Association Publishing House
Chinese Society of General Practice
Chronic Obstructive Pulmonary Disease Study Group of Chinese Thoracic Society
Editorial Board of Chinese Journal of General Practitioners of Chinese Medical Association
Expert Group of Guidelines for Primary Care of Respiratory System Disease
Yang Ting
Chi Chunhua
Authors Info & Affiliations
Chinese Medical Association
Chinese Medical Association Publishing House
Chinese Society of General Practice
Chronic Obstructive Pulmonary Disease Study Group of Chinese Thoracic Society
Editorial Board of Chinese Journal of General Practitioners of Chinese Medical Association
Expert Group of Guidelines for Primary Care of Respiratory System Disease
Yang Ting
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing 100029, China
Chi Chunhua
Department of General Practice, Health Management Center, Peking University First Hospital, Beijing 100034, China
·
DOI: 10.3760/cma.j.cn114798-20240326-00174
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摘要

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)简称慢阻肺,是最常见的慢性呼吸系统疾病,在我国呈现高患病率、高死亡率和高疾病负担的流行病学特征,由于人口老龄化、庞大的吸烟和二手烟暴露人群、室内外空气污染、结核感染等因素的持续存在,慢阻肺的防控形势将十分严峻。近些年,以慢阻肺为代表的慢性呼吸系统疾病的防控越来越受到国家重视,陆续出台了一系列支持措施,包括在全国50%以上的基层医疗卫生机构配备便携式肺功能仪,为慢阻肺的早筛早诊打下了坚实的基础;随着分级诊疗政策的推进,基层医务人员的慢阻肺诊治管理能力也得到了极大提升。慢阻肺防控的关键在基层,为提高基层医务人员对慢阻肺的诊治水平,2018年,中华医学会受国家卫生健康委员会基层卫生健康司委托组织制定了《慢性阻塞性肺疾病基层诊疗指南(2018年)》并刊于《中华全科医师杂志》 1 , 2,是国内第一部由全科医学专家参与制定的面向基层的慢阻肺诊治管理指南。6年来,关于慢阻肺诊治的许多内容有了进一步的循证医学证据,也增加了一些新的概念。为此,在中华医学会、中华医学会杂志社的组织领导下,来自中华医学会全科医学分会、中华医学会呼吸病学分会慢阻肺学组、中华医学会《中华全科医师杂志》编辑委员会等的专家开展了指南的更新修订工作,形成《中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年)》。本次修订仍然坚持既往原则,由呼吸病学、全科医学和方法学专家联合制定,面向广大基层医务人员,体现“促、防、诊、控、治、康”六位一体的照护理念,突出基层的管理特色和实用性,希冀新指南成为基层慢阻肺规范管理的指引,惠及更多慢阻肺高危人群和患者。

肺疾病,慢性阻塞性;诊断;治疗;疾病管理;指南;基层
引用本文

中华医学会,中华医学会杂志社,中华医学会全科医学分会,等. 中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年)[J]. 中华全科医师杂志,2024,23(06):578-602.

DOI:10.3760/cma.j.cn114798-20240326-00174

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慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)简称慢阻肺,是最常见的慢性呼吸系统疾病,在我国呈现高患病率、高死亡率和高疾病负担的流行病学特征,由于人口老龄化、庞大的吸烟和二手烟暴露人群、室内外空气污染、结核感染等因素的持续存在,慢阻肺的防控形势将十分严峻。近些年,以慢阻肺为代表的慢性呼吸系统疾病的防控越来越受到国家重视,陆续出台了一系列支持措施,包括在全国50%以上的基层医疗卫生机构配备便携式肺功能仪,为慢阻肺的早筛早诊打下了坚实的基础;随着分级诊疗政策的推进,基层医务人员的慢阻肺诊治管理能力也得到了极大提升。慢阻肺防控的关键在基层,为提高基层医务人员对慢阻肺的诊治水平,2018年,中华医学会受国家卫生健康委员会基层卫生健康司委托组织制定了《慢性阻塞性肺疾病基层诊疗指南(2018年)》并刊于《中华全科医师杂志》 1 , 2,是国内第一部由全科医学专家参与制定的面向基层的慢阻肺诊治管理指南。6年来,关于慢阻肺诊治的许多内容有了进一步的循证医学证据,也增加了一些新的概念。为此,在中华医学会、中华医学会杂志社的组织领导下,来自中华医学会全科医学分会、中华医学会呼吸病学分会慢阻肺学组、中华医学会《中华全科医师杂志》编辑委员会等的专家开展了指南的更新修订工作,形成《中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年)》。本次修订仍然坚持既往原则,由呼吸病学、全科医学和方法学专家联合制定,面向广大基层医务人员,体现“促、防、诊、控、治、康”六位一体的照护理念,突出基层的管理特色和实用性,希冀新指南成为基层慢阻肺规范管理的指引,惠及更多慢阻肺高危人群和患者。
本次指南制定以贴合基层诊疗实际、基层临床适用性为目标,对部分主要诊疗意见进行了推荐,推荐意见的证据主要基于《慢性阻塞性肺疾病诊治指南(2021年修订版)》 3和《慢性阻塞性肺病诊断、治疗和预防全球策略(GOLD 2024)》 4,同时新增了部分新近发表的高质量文献证据。指南证据质量和推荐强度的分级标准采用GRADE(Grading of Recommendations Assessment,Development and Evaluation)方法( 表1 ),证据质量分为“高、中、低和极低”4个等级,分别用A、B、C 和D 表示;推荐意见分为“强推荐、弱推荐”两个级别。
证据质量 证据等级 解释
A 证据来自高质量的随机对照试验(RCT)或系统评价或Meta 分析
B 证据来自有研究缺陷的 RCT 或低质量的系统评价或Meta 分析、高质量的观察性研究
C 证据来自非随机、病例对照或其他观察性研究
D 专家意见
推荐强度 推荐等级
1 强推荐
2 弱推荐
证据质量和推荐强度分级标准
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
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备注信息
A
杨汀,中日友好医院呼吸中心呼吸与危重症医学科 国家呼吸医学中心,北京 100029,Email: mocdef.qabqgnitgnayrd
B
迟春花,北京大学第一医院全科医学科 北京大学第一医院健康管理中心,北京100034,Email: nc.defudabe.umjbihc.auhnuhc
C

国际实践指南注册与透明化平台(PREPARE-2023CN515)

D
中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年)[J]. 中华全科医师杂志, 2024, 23(6): 578-602. DOI: 10.3760/cma.j.cn114798-20240326-00174.
E
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F
中国医学科学院医学与健康科技创新工程项目 (2021-I2M-1-049)
中央高水平医院临床科研业务费 (2022-NHLHCRF-LX-01-0107)
国家重点研发计划 (2022YFC3601503)
北京市卫生健康科技成果和适宜技术推广项目 (BHTPP2022032)
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