慢性阻塞性肺疾病急性加重患者频繁再入院与其危险因素

Frequent Hospital Readmissions duo to Acute Exacerbation of COPD and their Associated Factors

目的 评价慢性阻塞性肺疾病 (COPD)患者急性加重频繁入院的危险因素。方法 调查两家大型医院因COPD急性加重入院的 196名中重度COPD患者。在患者出院时和出院后一个月稳定状态 ,收集患者的临床性状、社会性状、日常护理因素和过去一年中急性加重入院的频率 ,测定肺功能指标及精神状态。结果 196例COPD患者中 ,72 %过去一年中有一次以上再入院 ,4 8%有 2次以上 ,8%有超过 10次再入院。单变量分析显示男性、病程长、嗜用镇痛剂和安眠药、第 1秒用力呼气容量占预计值的百分比 (FEV1% ) <4 5 %、缺乏肺康复训练和严重气促与频繁再入院有显著相关性 (P <0 .0 5 )。多变量分析显示病程长 (OR =2 .6 0 )、FEV1% <4 5 % (OR =2 .0 3)、严重气促 (OR =2 .5 0 )和男性 (OR =3.13)与COPD急性加重再入院有独立显著相关性 (P <0 .0 5 )。结论 COPD急性加重频繁再入院与COPD严重程度。

Objective To ascertain rates of hospitalizations duo to acute exacerbations of COPD patients (AECOPD) and evaluate the association of risk factors with frequent admissions for acute exacerbations.Methods A study sample of 196 patients with moderate to severe COPD admitted for acute exacerbations to two large general hospitals were studied.Frequency of previous readmissions duo to COPD,socio-demographic,clinical and patient care characteristics,including depression and spirometry were ascertained in the stable state before discharge and after one-month discharge.Results Among the patients,72% had at least one previous readmission,48% had two or more,8% had more than 10 to 20 readmissions in the one year period prior to current admission. Univariate analysis showed that male gender,receipt of pulmonary rehabilitation,duration≥5yrs,FEV 1%<45% predicted,use of psychotropic drugs and severer dyspnea were significantly associated with frequent readmissions.Multivariate analysis showed that disease duration≥5yrs (OR=2.60),FEV 1%<45% predicted (OR=2.03),severer dyspnea (OR=2.50) and males (OR=3.13) were independently related to the risk of readmission for acute exacerbations.Conclusion Readmission duo to COPD exacerbation is associated with disease severity,psychosocial and health care factors that are modifiable.