慢性阻塞性肺疾病不同时期血清高敏C-反应蛋白水平变化

目的探讨血清高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)在评估慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)气道炎症及肺功能中的价值。方法采用乳胶凝集反应法检测60例COPD急性加重期患者入院时及经正规治疗5～10d进入稳定期时血清hs-CRP水平,并于稳定期检测患者肺功能,分析稳定期hs-CRP水平与1s用力呼气容积(forced expiratory volume in one second,FEV1)占预计值百分比(FEV1%)的关系。结果 COPD患者急性加重期、稳定期血清hs-CRP水平分别为(46.21±36.10),(8.49±8.83)mg/L,差异有统计学意义(P<0.01);COPD稳定期血清hs-CRP和FEV1%无相关性(r=-0.045,P=0.735)。结论血清hs-CRP可作为评估气道细菌感染程度的指标之一。     

营养支持对慢性阻塞性肺病急性加重期患者免疫和肺功能的影响

目的　探讨营养支持对慢性阻塞性肺病 (COPD)急性加重期患者合并营养不良的疗效及其对免疫和肺功能的影响。方法　COPD急性加重期合并营养不良患者 6 0例 ,随机分为胃肠外营养 (PN)组及对照组 ,给予为期 2周的PN支持。结果　 (1)临床疗效 :PN组有效率 93 3% ,对照组 70 0 % ,χ2 =4 0 1,P <0 0 5。 (2 )人体测量及生化检查 :PN组IBW %、TSF、MAMC及血清白蛋白明显增加。 (P <0 0 5 ) ,对照组无显著变化 (P >0 0 5 )。 (3)免疫功能检查 :PN组血TLC、CD3、CD4 、CD4 /CD8以及IgA显著性增加(P <0 0 5 ) ,对照组除血TLC显著性增加 (P <0 0 5 )外 ,其它指标无显著性变化 (P >0 0 5 )。 (4 )肺功能和血气检查 :PN组的FVC、FEV1 /FVC及PaO2 有明显改善 (P <0 0 5 ) ,对照组上述指标无显著性改变(P >0 0 5 )。结论　PN支持可以改善COPD急性加重期患者的免疫功能和肺功能 ,提高临床疗效。     

AECOPD患者再入院的危险因素分析

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者再入院的影响因素。方法 回顾性分析283例AECOPD患者临床资料,根据患者出院后90 d内是否非计划再入院分为再入院组75例和非再入院组208例,通过单因素及多因素logistic回归分析AECOPD患者再入院的影响因素。结果 283例AECOPD患者出院90d内非计划性再入院率为26.50%。logistic回归分析:年龄高(OR=1.893,95%CI:1.121～2.757)、营养不良(OR=2.604,95%CI:1.245～4.019)、FEF75预计值升高(OR=1.365,95%CI:1.057～2.562)、过去1年急性加重次数≥2次(OR=2.071,95%CI:1.319～3.280)为AECOPD患者非计划性再入院的独立影响因素。文化程度高(OR=0.722,95%CI:0.501～0.943)、FEV₁实际值升高(OR=0.513,95%CI:0.361～0.733)、坚持运动锻炼(OR=0.410,95%CI:0.282～0.741)为AECOPD患者再入院风险的保护因素。结论 年...     

慢性阻塞性肺疾病患者C反应蛋白测定及其临床意义

目的 探讨慢性阻塞性肺疾病(COPD)患者不同分期及不同分级血中C反应蛋白(CRP)浓度变化的临床意义,肺功能损害程度与CRP浓度变化的关系.方法 选择COPD急性加重期患者42例,入院时及经治疗病情好转进入缓解期出院前均进行肺功能第1秒用力呼气容量(FEV1)和1秒率(FEV1/FVC)测定;动脉血气分析:包括氧分压(PaO2)、二氧化碳分压(PaCO2)的测定;采集患者清晨空腹静脉血,采用ELISA法检测CRP浓度.同时,选择10名健康者作为对照组进行CRP测定.结果 急性加重期COPD患者血清CRP浓度较健康对照者明显增高[(6.283 ±3.168)mg/L与(0.134±0.040)mg/L,t=4.12,(P＜0.05)],COPD急性加重期Ⅳ级患者增高最明显,但各级之间差异无统计学意义(P＞0.05).COPD患者急性加重期比缓解期明显升高,差异有统计学意义[(6.283±3.168)mg/L与(4.104±1.013)mg/L;t =4.35,P＜0.05].COPD患者肺功能FEV1变化与血CRP浓度变化呈负相关(r=-0.618,P＜0.05),FEV1/FVC变化与血CRP浓度变化呈负相关(r=-0.629,P＜0.05).PaO2与血CRP浓度变化呈负相关(r=-0.605,P＜0.05),PaCO2与血CRP浓度变化呈正相关(r=0.613,P＜0.05).结论 CRP浓度的增高可能与呼吸困难程度及肺功能损害程度有关,但是CRP作为COPD患者病情进展和预后的独立指标还有待进一步研究.     

外周血PRDX6与稳定期COPD患者临床特征及频繁急性加重的关系

目的 研究外周血过氧化物酶6(PRDX6)与稳定期慢性阻塞性肺疾病（COPD）患者临床特征及频繁急性加重的关系。方法 选择2021年1月至2022年12月期间寿县人民医院呼吸内科收治的80例稳定期COPD患者作为研究对象。根据既往12个月内急性加重情况分为频繁急性加重组（n=42）和非频繁急性加重组（n=38）。比较两组患者外周血PRDX6水平及临床指标的差异,采用logistic回归模型分析稳定期COPD患者频繁急性加重的影响因素。结果 频繁急性加重组的外周血PRDX6水平、第一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）、FEV1占预计值百分比（FEV1/pred）低于非频繁急性加重组,差异有统计学意义（t=14.509、4.302、5.755、4.907,P<0.05）,BODE指数、COPD评估测试（CAT）评分均高于非频繁急性加重组,差异有统计学意义（t=4.391、9.212,P<0.05）;稳定期COPD患者外周血PRDX6水平与FEV1、FEV1/FVC、FEV1/pred呈正相关（r=0.341、0.327、0.401、0.294、0.301...     

延伸护理对COPD稳定期患者自我效能及BODE指数的影响

目的探讨延伸护理在COPD稳定期患者中的应用及其对患者自我效能及BODE指数的影响,旨在为COPD的整体护理提供参考。方法选取COPD稳定期患者86例,随机分为观察组与对照组,每组43例。对照组采用传统的门诊随访模式;观察组采用延伸护理模式,采取即时通讯平台互动、家庭访视、门诊复查等实施护理指导,重点指导呼吸肌功能锻炼、家庭氧疗等。比较两组患者出院时、出院3个月后、出院6个月后的自我效能评分及BODE指数,以及两组患者出院6个月内急性加重的再入院情况。结果观察组与对照组有效受试者分别为40例、39例。出院3个月后、6个月后,观察组GSES评分、BMI、FEV1%、6MWD均高于对照组,MMRC、BODE评分均低于对照组,差异均具有统计学意义(P0.05)。观察组相比对照组因急性加重再入院率降低,分别为7.50%、25.64%,差异有统计学意义(P0.05)。结论延伸护理使COPD稳定期患者得到了持续的康复护理指导,提高了患者的自我效能,改善了BODE指数,且降低了患者急加重再入院的频次,具有较好的护理干预效果,体现了整体护理的价值,对COPD及慢性病的家庭康复具有一定的指导意义。     

慢性阻塞性肺疾病患者血清TNF-α、IL-8及VEGF水平变化及其与呼吸功能的相关性

目的 探讨血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)及血管内皮生长因子(VEGF)的水平变化与慢性阻塞性肺疾病(COPD)患者的肺功能及病情变化的相关性。方法 同步收集郑州市第一人民医院2017年6月至2019年3月收治的COPD急性加重期患者(AECOPD组) 44例、COPD稳定期患者(COPD组) 41例和健康对照组45例,检测血清TNF-α、IL-8浓度及肺功能指标的差异性,分析TNF-α、IL-8与VEGF与肺功能指标及病情变化程度的相关性。结果 对照组、COPD组、AECOPD组血清TNF-α、IL-8及VEGF的浓度比较,差异有统计学意义(P 0. 05),血清TNF-α、IL-8随着COPD患者病情加重而逐渐升高(P 0. 05),VEGF随着COPD患者病情加重而逐渐降低(P 0. 05); AECOPD组和COPD组患者的血清TNF-α、IL-8及VEGF均与第1秒用力呼气容积(FEV1)占最大用力肺活量(FVC)的比值(FEV1/FCV)和FEV1%呈负相关,VEGF与FEV1%、FEV1/FVC均呈正相关。结论 血清TNF-α、IL-8及VEGF等细胞因子在COPD的发病及加重期具有重要意义,并与肺功能下降关系密切。     

用多因素分级系统指数评价慢性阻塞性肺疾病病人生活质量的研究

[目的]探讨多因素分级系统(BODE)指教与慢性阻塞性肺疾病(COPD)病人生活质量的相关性.[方法]选择因COPD急性加重入院治疗后病情平稳的病人40例,于出院当日测量BODE指数及各因子评分,包括体重指数(BMI)、第1秒用力呼气容积占预计值百分比(FEV2%)、呼吸困难评分、6 min步行试验.同时采用St George'S呼吸问卷评价病人的生活质量.[结果]BODE指数与活动能力、疾病影响及总分呈正相关,比FEV1%与生活质量的相关性更强.[结论]BODE指数与的前的FEV1%相比能更好地评价COPD病人生活质量.     

氨茶碱治疗慢性阻塞性肺疾病急性加重期14例疗效观察

目的:观察氨茶碱治疗COPD急性加重期患者的疗效.方法:COPD急性加重期患者27例,随机分为2组,对照组(13例)予常规吸氧及化痰治疗,并予抗菌药物治疗,观察组(14例)在上述治疗的基础上同时给予氨茶碱0.2～0.4 g/d,疗程为3个月.观察2组的COPD症状缓解所需时间,于急性加重期(入院当日)、缓解期第1日、缓解期第3个月测定FEV1、FEV1/FVC值;并用紫外线分光光度计法测定缓解期第1日、第3个月茶碱血药浓度.结果:观察组症状缓解所需时间短于对照组[(9±3)d比(12±3)d,P＜0.05].观察组COPD缓解期第3个月的FEV1、FEV1/FVC值高于急性加重期COPD缓解期第3个月,与对照组比较,观察组FEV1及FEV1/FVC值改善程度较优(均为P＜0.05).观察组缓解期第1日与缓解期第3个月的茶碱血药浓度比较差异无统计学意义(P＞0.05).结论:氨茶碱治疗可缩短COPD急性加重期患者症状缓解所需时间,改善COPD缓解期肺功能,治疗期间茶碱血药浓度基本在治疗窗上下限范围内波动,其治疗价值应受到关注.     

脑钠肽水平在慢性阻塞性肺疾病急性加重期和左心功能不全患者中的临床意义

目的探讨慢性阻塞性肺疾病(COPD)急性加重期和左心功能不全患者血浆中脑钠肽(BNP)水平和临床意义。方法住院治疗的55例左心功能不全患者和COPD患者,在其入院时测得BNP水平,进行相关性分析。结果左心功能不全患者BNP水平明显高于COPD患者(P<0.01);BNP浓度与第一秒钟用力呼气容积(FEV1)/预计值百分比呈负相关(r=-0.868,P<0.01);BNP浓度与LVEF之间呈负相关(r=-0.929,P<0.01);BNP>200 pg/ml时左心功能不全患者数目大于COPD患者。结论左心功能不全的患者BNP水平明显高于COPD急性加重期患者,BNP能帮助鉴别COPD急性加重期与左心功能不全。     

稳定期慢性阻塞性肺疾病频繁急性加重的影响因素及其与血清SFRP1、PGRN水平的相关性

目的:探究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)频繁急性加重的影响因素及其与血清分泌型卷曲相关蛋白1(secreted frizzled-related protein 1,SFRP1)、颗粒蛋白前体(progranulin,PGRN)水平的相关性。方法:选取2020年4月至2021年2月于汕头市大峰医院呼吸内科就诊的稳定期COPD患者为研究对象,根据患者既往12个月内症状急性加重的情况,将其分为频繁急性加重组和非频繁急性加重组。采集所有患者一般资料,进行肺功能检查、常规生化指标及血清SFRP1、PGRN水平测定,并行改良英国医学研究委员会呼吸困难量表(modified Medical Research Council Dyspnea Scale,mMRC)、临床慢性阻塞性肺病问卷(Clinical COPD Questionnaire,CCQ)、Charlson合并症指数(Charlson Comorbidity Index,CCI)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估。采用logistic回归模型分析相关指标与COPD频繁急性加重的关系。结果:共入组160例,其中频繁急性加重组为92例,非频繁急性加重组68例。与非频繁急性加重组相比,频繁急性加重组的体重指数(body mass index,BMI)、第1秒用力呼气容积(forced expiratory volume in one second,FEV₁)、FEV₁/用力肺活量(forced vital capacity,F VC)及血清肾小球滤过率(glomerular filtration rate,GFR)、血红蛋白(haemoglobin,Hb)水平均明显更低(P<0.05),血清总免疫球蛋白E(immunoglobulin E,IgE)、SFRP1、PGRN水平及慢性阻塞性肺病评估测试(COPD assessment test,CAT)、HAMA评分则均明显更高(P<0.05)。Logistic回归分析显示:BMI[优势比(odds ratio,OR)=0.973]、FEV₁(OR=0.963)、GFR(OR=0.865)、血清总IgE(OR=3.473)、SFRP1(OR=2.081)、PGRN(OR=2.612)及CAT评分(OR=1.101)、HAMA评分(OR=1.134)均为稳定期COPD频繁急性加重的独立影响因素(P<0.05)。结论:相比非频繁急性加重患者,COPD频繁急性加重患者存在BMI较低、肺功能较差等特点,且血清SFRP1、PGRN水平与频繁急性加重具有明显相关性。     

Trends in Readmission Rates,Hospital Charges,and Mortality for Patients With Chronic Obstructive Pulmonary Disease (COPD) in Florida From 2009 to 2014

Purpose

Chronic obstructive pulmonary disease (COPD) is a leading and costly cause of readmissions to the hospital, with one of the highest rates reported in Florida. From 2009 to 2014, strategies such as readmission reduction programs, as well as updated guidelines for COPD management, were instituted to reduce readmission rates for patients with COPD. Thus, the question has been raised whether COPD-related 30-day hospital readmission rates in Florida have decreased and whether COPD-related readmission costs during this period have changed. In addition, we examined trends in length of stay, hospital charges, and in-hospital mortality associated with COPD, as well as identified patient-level risk factors associated with 30-day readmissions.

Chronic obstructive pulmonary disease management: the evidence base.

In long-term management of stable chronic obstructive pulmonary disease (COPD), a number of medications improve pulmonary function test results. The long-term clinical benefits of those drugs would seem intuitive, but there is very little strong evidence that long-term outcomes in COPD are substantially affected by those drugs. Nevertheless, symptom improvement such as dyspnea reduction is certainly strong reason to use those agents. The 2 most compelling bodies of evidence in stable COPD are for oxygen therapy in the chronically hypoxemic patient and pulmonary rehabilitation to improve exercise tolerance and dyspnea. Inhaled corticosteroids also appear to be useful in patients at risk for frequent exacerbations. In acute exacerbations, the rationale for therapy comes in part from the large body of literature regarding acute asthma therapy. Bronchodilator therapy and corticosteroids both seem to reduce the severity and the duration of exacerbations. Moreover, routine antibiotic use seems beneficial, and the role of noninvasive positive-pressure ventilation with patients suffering impending respiratory failure from acute COPD exacerbations is well supported by the literature.     

Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention

BACKGROUND: The high cost of caring for patients with congestive heart failure (CHF) results primarily from frequent hospital readmissions for exacerbations. Home nurse visits after discharge can reduce readmissions, but the intervention costs are high. OBJECTIVES: To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges: 1) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope; 2) nurse telephone calls; and 3) usual outpatient care. RESEARCH DESIGN: One-year randomized trial. SUBJECTS: English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF. MEASURES: Our primary outcome was CHF-related readmission charges during a 6-month period after randomization. Secondary outcomes included all-cause readmissions, emergency department (ED) visits, and associated charges. RESULTS: Thirty-seven subjects were randomized: 13 to home telecare, 12 each telephone care and 12 to usual care. Mean CHF-related readmission charges were 86% lower in the telecare group ($5850, SD $21,094) and 84% lower in the telephone group ($7320, SD $24,440) than in the usual care group ($44,479, SD $121,214). However, the between-group difference was not statistically significant. Both intervention groups had significantly fewer CHF-related ED visits (P = 0.0342) and charges (P = 0.0487) than the usual care group. Trends favoring both interventions were noted for all other utilization outcomes. CONCLUSIONS: Substantial reductions in hospital readmissions, emergency visits, and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring. Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive.     

Intensive care unit survivors have fewer hospital readmissions and readmission days than other hospitalized patients in British Columbia

OBJECTIVE: Intensive care unit (ICU) patients who survive their hospital admission have a long-term survival that is similar to that of hospitalized patients who do not require ICU admission. The risk of future readmission to the hospital for these two patient groups is unknown. The objective of this study was to determine the association between ICU admission and number of readmissions to the hospital and number of readmission days. DESIGN: Cohort study for 3 yrs between 1994 and 1997. SETTING: All acute care hospitals in British Columbia, Canada. PATIENTS: A total of 23,859 patients admitted to the ICU and 40,052 patients admitted to the hospital but not the ICU (5% random sample of total). INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We measured the number of readmissions to the hospital and the number of readmission days after discharge from the first admission to the hospital during the study period. For survivors to the end of the study period, patients who had been in the ICU had 0.66 readmissions per year and 5.29 readmission days per year compared with 0.73 readmissions per year and 5.48 readmission days per year for control subjects. After controlling for age, sex, socioeconomic status, number of previous ICU and hospital admissions, major clinical category during index admission, comorbidity score during index admission, length of hospital stay during index admission, size of index hospital, and period of follow-up, ICU admission was associated with fewer readmissions (survivors: rate ratio, 0.80; 95% confidence interval, 0.77-0.82; nonsurvivors: rate ratio, 0.85; 95%, confidence interval, 0.82-0.89) and readmission days (survivors: rate ratio, 0.91; 95% confidence interval, 0.87-0.95; nonsurvivors: rate ratio, 0.87; 95%, confidence interval, 0.81-0.92) than admission to the hospital but not the ICU. CONCLUSIONS: Survivors of a hospital stay that includes admission to an ICU have fewer hospital readmissions and readmission days after their discharge than do survivors of a hospital stay without intensive care.     

Predictors of Hospital Admission for Chronic Obstructive Pulmonary Disease Exacerbations in Canadian Emergency Departments

Objectives: The objective was to examine predictors of hospital admission among adults presenting to Canadian emergency departments (EDs) for acute exacerbations of chronic obstructive pulmonary disease (COPD). Current acute treatment approaches and outcomes 2 weeks after the ED visit are also described. Methods: Subjects, aged ≥35 years presenting with COPD exacerbations to 16 EDs across Canada, underwent a structured in‐ED interview and a telephone interview 2 weeks later. Results: Of 501 study patients, 247 (49.3%; 95% confidence interval [CI] = 44.9% to 53.6%) were admitted. Admitted patients were older, were more often former smokers, and had more admissions for COPD during the past 2 years. They also reported more days of activity limitation and use of inhaled beta₂‐agonists in the previous 24 hours. Canadian Triage and Acuity Scale (CTAS), respiratory rate (RR), and airflow obstruction were more severe in the hospitalized group. Most of the patients received inhaled beta₂‐agonists, anticholinergics, oral corticosteroids (CS), and antibiotics; hospitalized patients received more aggressive treatments. The median ED length of stay (LOS) of admitted patients was 13.1 hours (interquartile range [IQR] = 7.4‐23.0) compared to 5.6 hours (IQR = 4.2‐8.4) in discharged patients. Admission was associated with at least two COPD admissions in the past 2 years (odds ratio [OR] = 2.10; 95% CI = 1.24 to 3.56), receiving oral CS for COPD (OR = 1.72; 95% CI = 1.08 to 2.74), having a CTAS score of 1–2 (OR = 2.04; 95% CI = 1.33 to 3.12), and receiving adjunct ED treatments (OR = 3.95; 95% CI = 2.45 to 6.35). Use of EDs for usual COPD care was associated with a reduced risk of admission (OR = 0.43; 95% CI = 0.28 to 0.66). Conclusions: Exacerbations of COPD in Canadian EDs result in prolonged ED stays and approximately 50% hospitalization despite aggressive acute treatment approaches. Historical, severity, and treatment‐related factors were strongly associated with hospital admission. Validation of these results should be completed prior to widespread use.     

Factor analysis of laboratory and clinical measurements of dyspnea in patients with chronic obstructive pulmonary disease

The primary purpose of this study was to determine if there are three distinct factors representing ratings of dyspnea during laboratory exercise, clinical ratings of dyspnea, and pulmonary function in patients with moderate to severe chronic obstructive pulmonary disease (COPD) (n = 92) using factor analysis. Subjects (mean age 66 +/- 7 yrs; FEV1% predicted 44.7 +/- 14.0) were randomly assigned to one of three treatment groups to test the effects of three education and exercise training programs. Outcomes were evaluated at baseline and at 2 months after the intervention. Dyspnea ratings with laboratory exercise (SOB) were measured during incremental (ITT) and endurance (ETT) treadmill tests, and a six-minute walk (6MW) using the modified Borg scale. Clinical measures of dyspnea were measured with the Baseline and Transitional Dyspnea Index (BDI/TDI), UCSD Shortness of Breath Questionnaire (SOBQ), Medical Research Council Dyspnea Scale (MRC), Dyspnea subscale of the Chronic Respiratory Questionnaire (CRQ-D), and a global dyspnea question. Pulmonary function parameters included FEV1% predicted, FEV1/FVC, and RV/TLC. The factor analysis yielded three factors that accounted for 58.7% of the total variance in the data: Factor 1, "Dyspnea with Laboratory Exercise" comprised ETT SOB end, ETT SOB isotime, ITTSOB end, ITT SOB isotime, ITT SOB/Time and ETT SOB/Time. Factor 2, "Clinical Dyspnea," comprised 6MW SOB, 6MW SOB/Feet, BDI, SOBQ, MRC, Global SOB, CRQ-D. Measures of airway resistance (FEV1% predicted, FEV1/FVC) and hyperinflation (RV/TLC) loaded on a third factor, "Pulmonary Function." An additional post hoc factor analysis with post-intervention data provided similar results. The Global SOB question and ITT SOB isostage variables were relatively more sensitive to change compared to the other outcome variables. We conclude that pulmonary function, clinical ratings of dyspnea, and laboratory ratings of dyspnea are three separate and independent factors and should be included in the routine clinical evaluation of patients with COPD.     

慢性阻塞性肺疾病急性加重期痰培养细菌学分析

目的探讨慢性阻塞性肺疾病（COPD）急性加重期痰细菌学状况以及细菌感染与肺功能损害、临床资料的关系。方法对2007年8月至2009年7月114例COPD急性加重病例进行回顾性分析。结果65例痰培养结果阳性者中有革兰阴性杆菌43株（66．15％）;革兰阳性球菌16株（24．62％）;革兰阴性球菌6株（9．23％）。细菌感染前4位依次是：铜绿假单胞菌12株（18．46％）,肺炎克雷伯杆菌10株（15．38％）,肺炎链球菌8株（12．31％）,大肠埃希菌7株（10．77％）。FEV1％〈50％及3个月内全身糖皮质激素应用时痰细菌培养阳性率,细菌分类与对应FEV1％≥50％、无全身糖皮质激素应用时比较有统计学差异（P〈0．05）。结论对COPD急性加重期患者,呼吸道感染以革兰阴性细菌为主,痰细菌学培养结果与患者肺功能损害、三个月全身皮质激素应用关系密切。     

布地奈德在慢性阻塞性肺疾病急性加重期的临床疗效观察

目的评价局部吸入布地奈德治疗慢性阻塞性肺疾病急性加重期的疗效及安全性。方法选择60例COPD急性加重期住院患者随机均分为3组:①布地奈德组给予布地奈德雾化液雾化吸入2 mg/次,每8小时1次;②泼尼松组给予口服泼尼松片30 mg/次,每日1次;③空白对照组不使用任何糖皮质激素。观察3组患者治疗后呼吸困难评分、肺功能和动脉血气变化。结果与空白对照组比较,布地奈德组、泼尼松组在治疗后呼吸困难评分、动脉血气及肺功能的改善有显著性差异(P0.05)。布地奈德组与泼尼松组在提高FEV1、PaO2,改善呼吸困难评分方面无显著性差异(P0.05)。但在PaCO2值下降方面,在治疗7 d后布地奈德组下降(4.4±1.5)mmHg,泼尼松组下降(5.3±2.2)mmHg,两组比较有显著性差异(P0.05)。布地奈德组的不良反应少于泼尼松组。结论布地奈德组的疗效明显优于空白对照组,但与泼尼松组的无显著性差异。局部吸入布地奈德溶液是COPD急性加重期有效选择。     

Factors contributing to hospital readmission in a Hong Kong regional hospital: a case-controlled study

BACKGROUND: As many as 50% of total hospital admissions are readmissions. Because the factors contributing to hospital readmission are multiple, and research findings are not conclusive, it is important for clinicians to gain an understanding of the key factors that contribute to readmission. OBJECTIVES:This study explores the factors contributing to hospital readmission and derives an explanatory model that can best identify characteristics of patients at high risk for hospital readmission. METHODS: This research was a case-controlled study with readmitted patients (n = 168) as the readmitted group and non-readmitted patients (n = 98) as the control group. The variables included demographic data, health assessment data, medical diagnosis, frequency of admissions, severity of illness, intensity of service and improvement of condition. The study sample was also interviewed to explore the patients' views on their repeated hospitalization. RESULTS: In the bivariate analysis significant differences between the study and control groups were multiple and generally consistent with findings in other studies. Using multiple logistic regression, however, the final model shows that only three factors best predict readmissions: frequency (3-4 times) of readmissions (OR = 9.96, p < .0001) and frequency (more than 5 times) of readmissions (OR = 15.73, p < .0001), financial assistance (OR = 5.03, p < .001), and severity of illness (OR = 3.12, p < .01). Our interview data suggest that the readmitted patients required assistance to accomplish daily living activities upon discharge and often returned to the hospital for the same health reason. CONCLUSION: The study findings suggest that patients who are frequently readmitted to the hospital are severely ill; are on public assistance; and may need special attention when discharged in order to attenuate repeated hospital readmission.