慢性阻塞性肺疾病急性加重患者住院治疗相关危险因素分析

摘要

Objective To investigate the risk factors associated with hospital admission for acute exacerbation of obstructive pulmonary disease (AECOPD).Methods One hundred and twenty-seven outpatients with AECOPD from the First Hospital of Shanxi Medical University were investigated through a cross-sectional and observational study.They were divided into inpatient treatment group and ambulatory treatment according to treatment.First,we studied the four types of 23 possible factors with single-factor analysis,then the factors with P value below 0.05 in single-factor analysis were proceeded to perform the multiple-factor analysis with logistic regression.We analyzed the risk factors associated with hospital admission for AECOPD.Results The single-factor analysis showed that patients with at least one visit to the hospital emergency room(ER) in the previous year[70％ (35/50)vs 22.1％ (17/77)],mucolytic cure[54％ (27/50) vs 28.6％ (22/77)],oxygen therapy[42.9％ (21/50) vs 10.4％ (8/77)),the number of visits to the ER[(2.0 ± 0.3) vs (0.6 ± 0.1)],PaO2 [(63 ± 11)mm Hg vs (72 ± 11) mm Hg],PaCO2 [(47±9)mm Hgvs (43 ±8)mm Hg],SaO2[(91±5)％ vs (94±3)％],Hb[(141±14)g/Lvs (149±14)g/L],WBC[(9.3±2.5) ×109/Lvs (8.1 ±2.2) ×109/L],the BODE index [(4.9±2.3) vs (3.0± 2.1)] and 6MWT [(315 ± 118) mvs (431 ± 117) m] were risk factors (P ＜ 0.05).According to the multiple-factor analysis of with Logistic regression analysis,there were 3 factors including the number of visits to the ER(OR:2.485,95％ CI:2.092-4.019),the BODE index (OR:3.303,95 ％ CI:3.054-5.610) and SaO2 (OR:0.658,95％ CI:0.561-0.967) (P ＜0.05).Conclusion Low SO2,high BODE index score and a greater number of visits to the ER may be the independent risk factors of hospital admission for AECOPD patients.%目的 探讨慢性阻塞性肺疾病急性加重(AECOPD)患者住院治疗相关危险因素,为患者住院诊疗提供依据.方法 横断面观察研究山西医科大学第一医院门诊的AECOPD患者127例,按治疗情况分为住院治疗组50例,非住院治疗组77例.先对2组可能的因素进行单因素分析,然后对单因素分析中P＜0.05的因素进行多因素Logistic逐步回归分析,寻找AECOPD住院治疗的相关危险因素.结果 住院治疗组与非住院治疗组单因素分析的比较中,前1年至少1次急诊住院[70.0％ (35/50)比22.1％ (17/77)]、化痰治疗[54.0％ (27/50)比28.6％(22/77)]、家庭氧疗[42.9％ (21/50)比10.4％ (8/77)]、前1年急诊入院次数[(2.0±0.3)次比(0.6±0.1)次]、PaO2[(63±11)mm Hg(1 mm Hg=0.133 kPa)比(71±11)mmHg]、PaCO2[(47±9)mm Hg比(43±8)mm Hg] 、SaO2[(91±5)％比(94±3)％]、血红蛋白含量[(141±14) g/L比(149±14) g/L]、白细胞计数[(9.3±2.5)×109/L比(8.1±2.2)×109/L]、BODE(B为体重指数,O为气流阻塞,D为呼吸困难,E为运动能力)指数[(4.9±2.3)比(3.0±2.1)]、6 min步行试验距离[(315±118)m比(431±117)m]差异均有统计学意义(均P＜0.05)；多因素Logistic回归分析结果显示前1年急诊住院次数[比值比(OR):2.485,95％置信区间(CI):2.092 ～4.019)],BODE指数(OR:3.303,95％ CI:3.054～5.610),SaO2(OR:0.658,95％ CI:0.561～0.967),均为AECOPD患者需住院治疗的独立危险因素.结论 较低的血氧饱和度、较高的BODE指数和前1年多次的急诊入院可能是AECOPD患者需住院治疗的独立危险因素.