慢性阻塞性肺疾病急性加重期患者近期预后的影响因素研究

Influencing Factors of Short-term Prognosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者近期预后的影响因素,为改善AECOPD患者预后提供参考。方法选取2016年1月—2018年2月芜湖市第二人民医院急诊内科、急诊重症监护病房收治的AECOPD患者115例,根据治疗后14 d预后分为预后良好组79例和预后不良组36例。比较两组患者一般资料和实验室检查指标,AECOPD患者近期预后的影响因素分析采用多因素Logistic回归分析。结果两组患者性别、高血压及糖尿病发生率、采用营养支持者所占比例比较,差异无统计学意义(P>0.05);预后良好组患者年龄小于预后不良组,病程、激素使用时间、机械通气时间短于预后不良组,冠心病发生率、白细胞计数及空腹血糖低于预后不良组,清蛋白高于预后不良组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.519,95%CI(1.103,1.795)]、冠心病[OR=4.341,95%CI(3.134,14.432)]、机械通气时间[OR=2.050,95%CI(0.429,9.797)]、清蛋白[OR=0.681,95%CI(0.397,0.851)]是AECOPD患者近期预后的影响因素(P<0.05)。结论年龄大、合并冠心病、机械通气时间长和清蛋白低是AECOPD患者近期预后较差的影响因素,临床上应针对上述因素进行积极干预,以改善患者预后。

Objective To investigate the influencing factors of short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),to provide a reference for preferably improving the prognosis.Methods From January 2016 to February 2018,a total of 115 patients with AECOPD were selected in the Department of Emergency Medicine and Emergency Intensive Care Unit,the Second People's Hospital of Wuhu,and they were divided into A group(with good prognosis,n=79)and B group(with poor prognosis,n=36)according to the prognosis 14 days after prognosis.General information and laboratory examination results were compared between the two groups,and multivariate Logistic regression analysis was used to analyze the influencing factors of short-term prognosis in patients with AECOPD.Results No statistically significant differences of gender,incidence of hypertension or diabetes,or proportion of patients received nutritional support was found between the two groups(P>0.05);age in A group was statistically significantly younger than that in B group,disease course,duration of using glucocorticoids and mechanical ventilation in A group were statistically significantly shorter than those in B group,incidence of coronary heart disease,WBC and FPG in A group were statistically significantly lower than those in B group,while albumin in A group was statistically significantly higher than that in B group(P<0.05).Multivariate Logistic regression analysis results showed that,age〔OR=1.519,95%CI(1.103,1.795)〕,coronary heart disease〔OR=4.341,95%CI(3.134,14.432)〕,duration of mechanical ventilation〔OR=2.050,95%CI(0.429,9.797)〕and albumin〔OR=0.681,95%CI(0.397,0.851)〕were influencing factors of short-term prognosis in patients with AECOPD(P<0.05).Conclusion Advanced age,merged with coronary heart disease,long-term mechanical ventilation and reduce of albumin are influencing factors of poor short-term prognosis in patients with AECOPD,which should be actively intervened to improve the patients'prognosis.