慢性阻塞性肺疾病急性加重期患者急性胃肠损伤发生率及其预后研究

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者急性胃肠损伤（AGI）的发生率及其对预后的评价。 方法分析2009年1月至2015年12月在马鞍山十七冶医院重症医学科收治的146例AECOPD患者的临床资料,进行AGI诊断和分级,依据28 d内存活情况,将发生AGI的患者分为存活组（72例）和死亡组（17例）,比较两组患者年龄、性别、合并症以及急性病生理学和长期健康评价（APACHEⅡ）评分、临床肺部感染评分（CPIS）。依据APACHEⅡ评分分值将AECOPD患者分成四组,轻度组（39例）、重度组（53例）、危重度组（35例）和极危重度组（19例）;另依据CPIS评分分值分成三组,轻度组（71例）、中度组（53例）和重度组（22例）,比较各分组间AGI发生率和28 dAGI病死率。同时对不同AGI分级患者的28 d病死率也进行比较。 结果146例AECOPD患者中有89例发生AGI,发生率为60.96%,其中Ⅰ级53例（59.55%）、Ⅱ级19例（21.35%）、Ⅲ级11例（12.36%）、Ⅳ级6例（6.74%）。AECOPD合并AGI患者存活组和死亡组的年龄、性别、合并症等比较,差异均无统计学意义（P均> 0.05）;但存活组患者APACHEⅡ评分（20 ± 5）分vs.（28 ± 5）分,t = 5.833,P< 0.001]、CPIS评分（3.5 ± 1.5）分vs.（5.4 ± 1.6）分,t = 4.568,P< 0.001]均显著低于死亡组。APACHEⅡ评分分组中AGI发生率和28 dAGI病死率各组比较,差异均有统计学意义（χ² = 27.369、47.838,P均< 0.001）;而CPIS评分分组中AGI发生率和28 dAGI病死率各组比较,差异也均有统计学意义（χ² = 24.025、47.453,P均< 0.001）。不同AGI分级患者28 d病死率比较（1.89%、15.79%、63.64%和100.00%）,差异有统计学意义（χ² = 49.829,P < 0.05）。 结论AECOPD患者AGI发生率高,且AGI分级越高,预后越差,应当重视AECOPD患者AGI的诊治。

The incidence rate of acute gastrointestinal injury and its prognostic value in patients with acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo investigate the incidence rate of acute gastrointestinal injury (AGI) and its effect on prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThe diagnosis, grades of AGI and other clinical data of 146 cases of AECOPD patients admitted from January 2009 to December 2015 in Maanshan Shiqiye Hospital were studied retrospectively. AECOPD patients with AGI were divided into the survival group (n = 72) and death group (n = 17) according to the survival condition within the 28-day period. The age, gender, complications and acute physiology and chronic health evaluation (APACHE) Ⅱscore, clinical pulmonary infection score (CPIS) and AGI grades were compared between the two groups. Based on APACHEⅡscores, AECOPD patients were divided into four groups: mild group (n = 39), severe group (n = 53), critically severe group (n = 35), and extremely severe group (n = 19). The incidence rate and 28-d mortality of AGI were evaluated among these four groups. According to CPIS, the patients were divided into three groups: mild group (n = 71), moderate group (n = 53), and severe group (n = 22); comparing the incidence rate and 28-d mortality of AGI in these three groups. Meanwhile, the 28-d mortality in different grades of AGI patients were analyzed. ResultsAmong 146 AECOPD patients, 89 patients (60.96%) had AGI, and there were 53 (59.55%), 19 (21.35%), 11 (12.36%) and 6 (6.74%) cases in AGI grade Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively. There were statistically significant differences of prognosis among different AGI grades (P < 0.05). There was no difference in age, gender and complications between the survival group and death group (all P > 0.05). However, the APACHEⅡscore (20 ± 5) vs. (28 ± 5), t = 5.833, P< 0.001] and CPIS (3.5 ± 1.5) vs. (5.4 ± 1.6), t = 4.568, P< 0.001] of the survival group were significantly lower than those of the death group. The incidence rate and 28-d mortality of AGI were significantly different in four APACHEⅡscore groups (χ² = 27.369, 47.838; all P< 0.001), and also different in three CPIS groups (χ² = 24.025, 47.453; all P< 0.001). In addition, the differences of 28-d mortality in four grades of AGI patients were statistically significant (1.89%, 15.79%, 63.64%, 100.00%; χ² = 49.829, P < 0.05). ConclusionsThe incidence rate of AGI in AECOPD patients is quite high. The higher the AGI grade, the worse the prognosis. Thus, we should pay attention to the diagnosis and treatment of AGI in AECOPD patients.