慢性阻塞性肺疾病住院患者误吸与远期生存的相关性分析

Correlation between aspiration and long-term survival of inpatients with chronic obstructive pulmonary disease

目的分析住院的慢性阻塞性肺疾病(简称慢阻肺)患者误吸的影响因素并探讨误吸与远期生存的相关性。方法回顾性纳入广州医科大学附属第一医院2012年4月至2013年12月因慢阻肺急性加重同时进行放射性核素唾液法误吸检测的住院患者53例,其中男48例,女5例,年龄53~90(72.5±9.3)岁,分析其临床资料。通过病历管理系统记录的联系电话进行持续电话随访,以患者死亡为随访终点,记录死亡原因,通过logistic回归方程分析危险因素。结果最后1例患者到达随访终点时间为2017年2月20日,从第1例患者进行误吸检查至最后1例患者随访结束时间跨度为58个月。53例中16例放射性核素唾液法误吸检测阳性(16/53,30.2%),年龄稍高于非误吸者(76.0±6.8比70.9±9.9),差异没有统计学意义(P=0.064)。年龄≥70岁人群误吸发生率为14/35,70岁以下人群误吸发生率为2/18,差异有统计学意义(P=0.03);误吸阳性者慢阻肺急性加重期合并肺炎比例高于阴性者(11/16比9/37,χ^(2)值为9.383,P=0.002);53例接受误吸检查,随访结束时41例发生因慢阻肺急性加重住院,阳性者年平均急性加重住院次数为(1.6±1.3)次,阴性者为(1.5±1.2)次,差异无统计学意义。21例死亡,死亡患者年平均急性加重住院次数高于存活者(2.3±1.4比0.9±0.9,P=0.001);误吸患者死亡主要诊断为重症肺炎,非误吸患者死亡主要诊断为肺性脑病(均P<0.05),存在误吸的慢阻肺患者中位生存期约为3年,而非误吸慢阻肺患者中位生存期约5年;多因素生存分析显示年龄是患者远期生存唯一影响因素。存在误吸的慢阻肺患者长期生存的高危因素为:既往入住ICU和合并肺炎。结论慢阻肺患者70岁以上人群中,误吸发生率高;与没有误吸者比较,存在误吸的慢阻肺患者肺炎发生率高、中位生存期短。年平均急性加重住院次数越高,死亡风险越大。影响误吸患者长期生存的高危因素是重症肺炎和既往入住ICU的病史,高龄患者误吸阳性率高,提示高龄慢阻肺患者死亡可能因为误吸的不断影响造成;为了提高误吸慢阻肺患者的生存时间,需重视误吸的防治。

Objective To retrospectively analyze the high risk factors of death in patients with chronic obstructive pulmonary disease(COPD)and to explore the influence of aspiration on the long-term survival rate of COPD patients.Methods A retrospective analysis of clinical data of inpatients,who were admitted to the First Affiliated Hospital of Guangzhou Medical University from April 2012 to December 2013 due to COPD exacerbations and had radionuclide aspiration test,was conducted.Meanwhile,we phoned the patients′family members,whose phone numbers were recorded in the electronic patient record system,to follow up the patients′survival status,and learn the causes of death from their death records if patients died during follow-up period.Inquired the resident administration patients belonging to according to their original address to get patient′s current contact information if changed.Besides,if family members of patients failed to provide death record,we should look up information concerned from the medical records room of the hospital where they died.Results The follow-up for the last patient was performed on February 20,2017.The time span of this study is 58 months,starting from the radionuclide aspiration test for the first patient and ending with the follow-up for the last patient.16 of the 53 patients(16/53,30.2%)were tested positive whose average age was slightly higher than patients without aspiration(76.0±6.8 vs 70.9±9.9),but there was no significant difference between them(P=0.064).The aspiration rates among patients over and under the age of seventy were 14/35 and 2/18 respectively,and there was a significant difference between them(P=0.03).Compared to the aspiration-negative patients,the aspiration-positive patients had higher incidence rate of pneumonia in COPD exacerbations(11/16 vs 9/37,χ^(2)=9.383,P=0.002).The major cause of death in the patients with and without aspiration were respectively severe pneumonia and pulmonary encephalopathy(P<0.05 in both cases).Among COPD patients who took radionuclide aspiration test,the median survival time of the patients with and without aspiration were about 3 and 5 years respectively.The high-risk factors influencing long-term survival of the COPD patients with aspiration included ICU-involved medical history and accompanying pneumonia.Conclusions The incidence rate of aspiration is relatively high in COPD patients over 70 years old.Compared to COPD patients without aspiration,COPD patients with aspiration have higher incidence rate of pneumonia and shorter median survival time.ICU-involved medical history and severe pneumonia are the two high-risk factors influencing long-term survival of COPD patients with aspiration.To improve the survival time of COPD patients with aspiration,we need to attach importance to the prevention and treatment of aspiration.