慢性阻塞性肺疾病急性加重期患者近期预后的危险因素分析

摘要

Objective To investigate the risk factors of prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinical data of all patients of AECOPD,admitted to Depart-ment of Respiratory Medicine of Foshan Fifth People's Hospital from February 2015 to March 2016,was retrospectively analyzed.The demographic data,medical history,stable treatment,exacerbation time and type,signs of admission,labo-ratory indexes,and mortality during hospitalization were collected,and the risk factors for in-hospital mortality in AE-COPD patients were analyzed.Results A total of 165 cases of patients were included in the study and 10 died during hospitalization.Univariate analysis showed that there were significant differences between the death and survival group in ages,numbers of acute exacerbation of hospitalization during the past one year,whether lived in ICU,Charlson comor-bidity index, body mass index, heart rate, respiratory rate, mMRC score, whether there was disturbance of conscious-ness, neutrophil-lymphocyte ratio (NLR), C reactive protein (CRP), albumin (ALB), urea nitrogen (BUN), D-dimer, N-terminal pro-brain natriuretic peptide(NT-proBNP),pH value,oxygenation index(PaO2/FiO2),carbon dioxide partial pressure(PaCO2)value(P<0.05).Multivariate Logistic regression analysis showed that Charlson comorbidity index≥3, mMRC=4, altered mental status were the independent risk factors for in-hospital mortality of patients with AECOPD. Conclusion Charlson comorbidity index≥3,mMRC=4,and altered mental status were the independent risk factors for in-hospital mortality of patients with AECOPD.%目的 探讨影响慢性阻塞性肺疾病急性加重(AECOPD)患者近期预后的危险因素.方法 连续收集2015年2月至2016年3月于佛山市第五人民医院呼吸内科住院治疗的所有AECOPD患者的临床资料,收集患者的人口学资料、病史、稳定期治疗、加重时间和类型、入院时体征、实验室指标,观察的结局事件是住院期间死亡,分析影响AECOPD患者住院死亡的危险因素.结果 共有165例患者纳入研究,住院期间死亡10例.单因素分析结果显示,死亡组和存活组患者在年龄、既往1年急性加重住院次数、是否曾住ICU、查尔森(Charlson)合并症指数、体重指数、心率、呼吸频率、mMRC评分、有无意识障碍、中性粒细胞/淋巴细胞比值、C反应蛋白(CRP)、白蛋白(ALB)、尿素氮(BUN)、D二聚体、N端脑钠肽前体(NT-proBNP)、酸碱值(pH值)、氧合指数(PaO2/FiO2)、二氧化碳分压(PaCO2)方面比较差异均具有统计学意义(P<0.05);多因素Logistic回归模型分析结果显示,Charlson合并症指数≥3、mMRC评分4分、有意识障碍是AECOPD患者住院死亡的独立危险因素(P<0.05).结论 Charlson合并症指数≥3、mMRC评分4分、有意识障碍是AECOPD患者住院死亡的独立危险因素.