慢性阻塞性肺疾病住院患者死因及合并症分析

Analysis of causes of mortality and comorbidity in hospitalized chronic obstructive pulmonary patients

目的了解慢性阻塞性肺疾病(COPD)住院患者的主要死因及合并症情况。方法回顾性分析2007年9月至2011年8月收治的1986例住院COPD患者的临床资料,其中死亡209例,分析COPD患者的主要死因及合并症情况。结果 COPD的主要死亡原因和COPD临床严重程度分级相关(P<0.01)。轻中度COPD患者70例,最常见的死亡原因是心血管系统疾病(34.3%)、肺癌(28.6%),其次是非恶性呼吸系统疾病(21.4%)。重度COPD患者50例,最常见的死亡原因是非恶性呼吸系统疾病(58.0%),其次是心血管系统疾病(24.0%)、肺癌(10.0%)。在89例极重度COPD患者中,最常见死亡原因是呼吸衰竭(43.8%)。死于肺癌的COPD患者组[(77±11)岁]较其他死亡原因组死亡年龄较轻(P<0.01)。死亡的COPD患者合并冠心病、呼吸衰竭、肺炎、心律失常、心力衰竭、消化性溃疡、肾功能不全、肿瘤、贫血、肺栓塞的比例分别为62.2%(130例)、58.9%(123例)、53.6%(112例)、36.8%(77例)、34.4%(72例)、32.1%(67例)、26.8%(56例)、26.3%(55例)、12.0%(25例)、3.3%(7例),均较存活患者发生率高(P<0.05),而高血压、糖尿病、肺结核、脑血管病等合并症两组比较差异无统计学意义(P>0.05)。结论住院COPD患者的主要死亡原因与COPD的严重程度相关。冠心病、呼吸衰竭、肺炎、心律失常、心力衰竭、消化性溃疡、肾功能不全、肿瘤、贫血等增加死亡风险。

Objective To investigate the main causes of death and comorhidities in hospitalized COPD patients. Methods The patients （n=1 986） with COPD who died （n=209） during hospitalization in our hospital from Septem- ber 2007 to August 2011 were retrospectively reviewed. The main causes of death in each stage of COPD and the rate of comorbidities were collected and analyzed. Results The predominant causes of death were related to the stage of COPD （P 〈 0.01）. In patients with mild and moderate COPD （n=70）, cardiovascular system disease （24, 34.3%）, lung cancer （20, 28.6%） were the most common causes of death, followed by non-malignant respiratory diseases （15, 22.4%）. In pa- tients with severe COPD （n=50）, the predominant cause of death was non-malignant respiratory diseases （29, 58.0%）, tol- lowed by cardiovascular system disease （12, 24.0%） and lung cancer （5, 10.0%）. In patients with very severe COPD （n=89）, the most common cause of death was respiratory failure （39, 43.8%）. The lung cancer was the frequent cause of death in young patients（P 〈 0.01 ）. The comorbidities including coronary heart disease（62.2%）, respiratory failure（58.9%）, pneumo- nia（53.6%）, arrhythmia（36.8%）, heart failure（34.4%）, peptic ulcer（32.1%）, renal insufficiency（26.8%）, tumor（26.3%）, ane- mia（12.0%）, pulmonary embolism（3.3%） were more common in deceased patients than in survivals（P 〈 0.05）. There was no statistical significance in hypertension, diabetes, pulmonary tuberculosis, cerebro-vascular disease between the deceased patients and survivals （P 〉 0.05）. Conclusion The main cause of death in inpatients with COPD is related to stage COPD. The comorbidities including coronary heart disease, respiratory failure, pneumonia, arrhythmia, heart failure, peptic ulcer, renal insufficiency, tumor and anemia may increase the risk of death in COPD patients.