住院急性加重期慢性阻塞性肺疾病患者病死率的影响因素研究

目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者在住院期间或出院1天内导致死亡的危险因素,为降低AECOPD病死率提供科学的建议。方法选择我院就诊的AECOPD患者126例,根据住院期间是否发生死亡分为死亡组(36例)和好转组(90例)。比较两组患者人口学特征、血常规、肺功能、血气分析、C反应蛋白(CRP)和并发疾病等相关指标;分析影响AECOPD患者住院病死率的因素。结果 APOPD患者126例中,死亡36例,好转90例。两组患者COPD综合评级高风险比例、CRP水平、血红蛋白、白蛋白、淋巴细胞计数、二氧化碳分压(PaCO2)、缺血性心脏病和肺源性心脏病比较,差异具有统计学意义(P0.05)。高CRP(OR=3.126,95%CI=1.345~7.265)、高碳酸血症(OR=3.012,95%CI=1.234~7.352)、低淋巴细胞计数(OR=2.341,95%CI=1.084~5.056)、慢性肺源性心脏病(OR=2.510,95%CI=1.203~5.237)是住院APOPD患者发生死亡的独立危险因素。结论高CRP、高碳酸血症、低淋巴细胞计数、并发慢性肺源性心脏病是影响住院AECOPD患者发生死亡的独立危险因素。

Factors influencing in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the influencing factors for hospitalization or one day after hospital discharge mortality of elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and to provide scientific suggestions for AECOPD prevention.Methods A total of 126 patients with AECOPD admitted for therapy in our hospital were divided into death group and improvement group according to whether they suffered from death during hospitalization.The demographic characters,blood routine parameters,pulmonary function,blood gas analysis,C reactive protein（CRP）and concurrent disease were compared between two groups.Additionally,the inhospital mortality in patients with AECOPD were analyzed.Results Among 126 patients,36cases died during hospitalization while another 90 cases improved.The proportion of high exacerbation risk,CRP level,hemoglobin,albumin,lymphocyte count,PaCO2,ischemic heart disease and pulmonary heart disease were statistically significant compared with the control group（P〈 0.05）.High sensitive C-reactive protein（OR =3.126,95%CI =1.345-7.265）,hypercapnia（OR =3.012,95%CI =1.234-7.352）,low lymphocyte count（OR =2.341,95%CI =1.084-5.056）,chronic pulmonary heart disease（OR =2.510,95%CI =1.203-5.237）were independent risk factors for AECOPD mortality.Conclusion The elevated CRP,hypercapnia,CPHD and lymphocyte count are influencing mortality factors for in-patients with AECOPD.