慢性阻塞性肺疾病急性加重患者30 d内不同预后的临床数据分析

Clinical data analysis of different prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease within 30 days

目的:通过临床数据回顾性研究,分析因慢性阻塞性肺疾病急性加重(AECOPD)入院,且住院时间在30 d内,死亡与好转出院患者临床数据的差异,筛选其中的高危患者,为个体化的治疗提供参考。方法:统计我院急诊科、呼吸科因AECOPD入院患者的临床资料,根据入院30 d内死亡或好转出院情况分为死亡组和出院组。对2组患者的临床资料进行多因素分析,并对2组患者的住院时间进行统计分析。结果:多因素显示GOLD D组(OR=8.612,95%CI:3.067~24.182,P<0.01),意识障碍(OR=11.838,95%CI:3.433~40.820,P<0.01),入院次数≥3次(OR=4.539,95%CI:1.251~16.466,P=0.021)与AECOPD患者30 d出现不同预后独立相关。住院时间Ⅰ组vs.Ⅱ组为(6.3±6.7)d vs.(10.5±4.9)d,P=0.009,Ⅰ组患者住院时间中位数为3(1~11)d。结论:GOLD D组、意识障碍、1年内多次入院(n≥3次)是因AECOPD入院患者30 d内死亡的独立危险因素,针对存在以上危险因素的患者应重点关注入院3 d内的病情变化,给予针对性的治疗,以降低患者的病死率。

Objective:To analyze the differences in clinical data between death and patients who were discharged from hospital retrospectively and screen for high-risk patients,providing a reference for individualized treatment.All patients were admitted to hospital with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and hospitalization was within 30 days.Method:Statistics of the Department of Emergency and Respiratory Departments of the Hebei petro china central hospital,from 2018.1.1~2018.12.31 clinical data of patients admitted to AECOPD.Enrollment conditions:①AECOPD for the main diagnosis of admission;②the patient died or improved discharge within 30 days.According to whether death is divided into 2 groups,Group I death group,Group II discharge group.Multivariate analysis was performed on the clinical data of the two groups of patients,and the hospitalization time of the two groups was statistically analyzed.Result:Multiple factors showed GOLD D group(OR=8.612,95%CI:3.067~24.182,P<0.01),disturbance of consciousness(OR=11.838,95%CI:3.433-40.820,P<0.01).The frequency of hospitalization(n≥3 times)(OR=4.539,95%CI:1.251-16.466,P=0.021),these three factors are independently associated with different prognosis within 30 days of AECOPD patients.The length of hospital stay GroupⅠVS GroupⅡwas 6.3±6.7 days VS 10.5±4.9 days,P=0.009.The median and quartile range of patients in Group I was 3(1~11)days.Conclusion:GOLD D group,disturbance of consciousness,and Frequency of admission within 1 year(n≥3 times)were independent risk factors for death within 30 days of admission due to AECOPD.Patients with the above risk factors should pay attention to the changes of the disease within 3 days after admission,and give targeted treatment to reduce the mortality of patients.