慢性阻塞性肺疾病住院患者对疾病的认知调查

目的了解慢性阻塞性肺疾病（COPD）患者对自身疾病的认知状况、并探讨其相关因素。旨在提高COPD患者对疾病的认识和生活质量,同时为健康教育提供理论依据。方法采用自行设计问卷,对海口市4家医院50名COPD患者进行问卷调查,患者均知情同意。结果①COPD患者以50～80岁在海南居住的人群为主;②患者的吸烟率为88%;患者戒烟率为93.18%;患者对疾病相关知识的认知水平不高;患者需要相关知识率为90%。结论影响COPD患者对疾病认知的主要因素有学历、职业、居住条件、经济状况、疾病知识来源等。     

慢性阻塞性肺疾病急性加重患者住院死亡结局预测模型研究

目的构建预测慢性阻塞性肺疾病(简称慢阻肺)急性加重住院死亡结局的临床模型。方法回顾性分析2016年1月1日至2019年6月30日于广东省中医院呼吸科与重症监护室收治的1767例慢阻肺急性加重患者。按7:3比例将数据随机分为训练集和验证集,通过多因素全子集回归在训练集中筛选变量特征,采用logistic回归方法建立模型。在验证集中通过受试者工作特征曲线(ROC)和曲线下面积(AUC)对模型进行区分度验证,通过绘制校准曲线和计算Brier评分对其进行准确度评价。结果共有133人发生院内死亡。经过变量筛选后,动脉二氧化碳分压(PaCO_2)、乳酸、白细胞、红细胞、NT-proBNP、D-二聚体、白蛋白、尿素氮是预测慢阻肺急性加重患者院内死亡的重要预后指标。模型方程为:死亡结局概率P=e~x/(1+e~x),X=0.7356+0.0822×D-二聚体+0.853×尿素氮+0.5627×乳酸+0.1271×白细胞-1.3835×红细胞+0.0002×NT-proBNP-0.1765×白蛋白+0.0622×PaCO_2。最大约登指数对应的死亡概率截断值为0.11,该点所对应的灵敏度为94.25%,特异度为97.21%。在验证集中模型预测患者发生院内死亡结局的AUC为0.9847,Brier评分为0.019。结论本文构建了一个临床预后模型,可以帮助临床医生预测慢阻肺急性加重患者个体的住院死亡概率,早期识别预后不良高危患者,服务于高质量的临床管理。     

慢性阻塞性肺疾病评估测试在慢性阻塞性肺疾病急性加重住院患者的临床应用

目的探讨慢性阻塞性肺疾病评估测试（CAT）在慢性阻塞性肺疾病急性加重（AECOPD）住院期间的临床应用价值。方法对AECOPD的住院患者在出院时进行肺功能检查,并应用CAT问卷进行症状评估,采用Pearson直线相关分析肺功能指标与CAT分值之间的相关性。根据肺功能对患者进行分级,并与根据CAT评分的分级进行比较,观察其对病情严重程度评估的一致性。结果CAT总分与FEVt％pred呈显著负相关（r=-0．557,P〈0．01）。CAT评分随患者病情加重而逐渐增加,病情严重程度不同的3组COPD患者,其CAT总分分别为（18±6）分、（21±7）分和（25±6）分,组间比较的差异有统计学意义（H=39．368,P〈0．01）。根据CAT分级和根据肺功能COPD严重程度分级比较,两者具有较高一致性。结论在AECOPD住院期间行肺功能检查及CAT评分,有助于病情严重程度的综合评估。     

慢性阻塞性肺疾病急性加重期患者住院期间死亡的危险因素研究

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者住院期间死亡的危险因素。方法 回顾性选取2020年1月至2023年3月青海省心脑血管病专科医院收治的AECOPD患者200例为研究对象,收集患者的临床资料,根据住院期间预后情况将患者分为存活组184例和死亡组16例。采用ROC曲线分析动脉血二氧化碳分压(PaCO₂)、胱抑素C(CysC)、降钙素原(PCT)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)预测AECOPD患者住院期间死亡的最佳截断值;采用多因素Logistic回归分析探讨AECOPD患者住院期间死亡的危险因素。结果 死亡组慢性阻塞性肺疾病(COPD)急性加重次数≥3次者占比、合并心力衰竭者占比、合并低蛋白血症者占比、PaCO₂、CysC、PCT、cTnI、BNP高于存活组(P<0.05)。ROC曲线分析结果显示,PaCO₂、CysC、PCT、cTnI、BNP预测AECOPD患者住院期间死亡的曲线下面积分别为0.840、0.730、0.808、0.860、0.735,最佳截断值分别为40.1 mm ...     

营养支持对慢性阻塞性肺疾病患者的临床作用

慢性阻塞性肺疾病（ＣＯＰＤ）以粉喘型（ｐｉｎｋｐｕｆｆｅｒ，ＰＰ）患者的营养不良尤为突出。重度营养不良的患者常常有体重进行性的下降，称为“肺恶液质综合征（ｐｕｌｍｏｎａｒｙｃａｃｈｅｘｉａｓｙｎｄｒｏｍｅ）”［１］。ＣＯＰＤ患者呼吸肌肌群功能的下降、易感染，亦常为营养不良的后果，故为这些患者提供营养支持成为治疗的合理组成部分［２］。本组研究目的为应用高脂肪类营养物质对ＣＯＰＤ患者进行夜间营养支持治疗，评价其对ＣＯＰＤ患者二氧化碳生成量（·ＶＣＯ２）、氧耗量（·ＶＯ２）、呼吸商（ＲＱ）、每分钟通气…     

慢性阻塞性肺疾病呼吸肌功能不全发病机制

研究发现慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者由于肺气肿、慢性低氧、高碳酸血症、营养不良及医源性因素等多种原因,呼吸肌尤其是膈肌可出现肌纤维发生结构及功能变化,导致呼吸肌功能不全.呼吸肌功能不全是发生呼吸衰竭的重要的病理生理机制之一.本文对COPD发生呼吸肌功能不全机制进行综述.     

慢性阻塞性肺疾病预后因素和死亡预测因子

慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）是一种人类的主要慢性疾病和死亡病因,目前已上升为人类致死病因的第四位。据预测在未来10年中COPD的发病率和致死率将进一步增高。近年来,许多有关的预后和死亡预测因子的众多指标成为目前国内外研究的热点,但由于不同研究者所采取的研究方式和角度不同,所得出的结论并不完全一致。以下即对各观点作一简要综述。     

慢性阻塞性肺疾病血生物学标记物

COPD是一个以轻度慢性全身性炎症为特点的疾病,血液循环中存在多种炎性生物标志物,如中性粒细胞、C反应蛋白、纤维蛋白原、肿瘤坏死因子α、IL-6和IL-8等.基于这些炎性生物标志物的各种研究正逐步揭示着COPD的发病机制及病理生理过程.     

慢性阻塞性肺疾病患者肺康复诊治进展

慢性阻塞性肺疾病(COPD)是目前普遍存在的以长期性呼吸道症状及气流受阻为特点的可避免和诊治的病症,气流受阻主要是有毒元素导致的气道及(或)肺泡不正常造成的[1]。COPD是当前在全世界范围内最常见且高发的非传染性慢性疾病。其患病率和病死率均较高,危害重大,是一个全球性亟待解决的公共卫生问题。有调查显示:中国COPD患者过去1年平均急性加重次数2次(1~3次)[2]。因此,除了明确诊断及精准治疗外,科学认识及早期预防COPD已经成为临床上面临的重大挑战。肺部康复治疗的目的是通过综合康复措施改善患者呼吸困难,使其活动耐力增强,生活质量、心理状态得到改善,患者社会适应能力得到提高[3]。2011年世界COPD控制策略(GOLD)中开始把肺康复诊治当做中重度COPD患者诊治的关键方式[4],此后指南多次更新均强调了肺康复在治疗中的地位。近年来,肺康复在我国虽然有了一定的发展,但很多医务人员及COPD患者仍对其缺乏认识,导致COPD患者不能有效利用肺康复进行自我管理。本文就肺康复的相关内容进行综述,为COPD患者的肺康复提供理论依据,进一步促进肺康复在我国的发展。     

慢性阻塞性肺疾病机械通气早期血乳酸测定的临床价值

慢性阻塞性肺疾病(COPD)急性发作常合并呼吸衰竭,需机械通气治疗.COPD的主要病理基础为低氧血症、感染、呼吸衰竭等导致的高代谢和高分解状态.血乳酸(LAC)是反映组织灌注及氧合状况的最敏感指标,与组织缺氧具有一定的相关性.LAC已经成为监测组织氧供的重要指标.本研究主要探讨COPD机械通气早期LAC的测定的临床价值.     

Prevalence of blood eosinophilia in hospitalized patients with acute exacerbation of COPD

In this cohort of 3084 patients hospitalized for acute exacerbation of COPD (AECOPD), we found that 17% had blood eosinophilia (≥300 cells/μL); the use of an alternative cut‐off level (≥2%) demonstrated that 40% had elevated eosinophil count. Patients with eosinophilia had higher frequency of readmission for AECOPD during 1‐year follow‐up period. This is the first study to investigate the prevalence of eosinophilia among inpatients with AECOPD—the population with the highest morbidity and health‐care utilization.     

Correlates of mortality in elderly COPD patients: Focus on health-related quality of life

Background and objective:   The Saint George Respiratory Questionnaire (SGRQ) is widely used as a measure of health-related quality of life (HRQL) in patients with COPD. This study tested whether the SGRQ predicts the survival of patients with COPD.
Methods:   The study recruited 238 patients with COPD who were participants in the multicentre Salute Respiratoria nell'Anziano (Sa.R.A.) study. Patients' sociodemographic, clinical and functional characteristics were assessed and the association between the SGRQ and mortality, corrected for potential confounders, was estimated.
Results:   The mean age of study participants was 72.6 years. Over the 5-year observation period there were 88 deaths. After adjustment for potential confounders, the SGRQ score was associated with an increased risk of dying (hazard ratio (HR): 1.22 for four-point increments; 95% confidence interval (CI): 1.02–1.45). There was no association between mortality and the Symptoms subscale (corrected HR: 1.13; 95% CI: 0.96–1.32), whereas each four-point increment of the Activity (HR: 1.20; 95% CI: 1.00–1.43) and Impact (HR: 1.38; 95% CI: 1.03–1.83) subscale scores were associated with increased mortality. Higher FEV₁ relative to predicted (HR: 0.73 for each 5% increment; 95% CI: 0.58–0.91) and better performance at the 6-min walking test relative to predicted (HR: 0.93 for each 5% increment; 95% CI: 0.89–0.97) were associated with lower mortality.
Conclusions:   In elderly COPD patients, the SGRQ can improve prognostic models based on classical indicators of disease severity.     

Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction

Aims

Patients with chronic kidney disease (CKD) have an excess of cardiovascular morbidity and mortality, with heart failure (HF) being particularly frequent. Reduced left ventricular ejection fraction (LVEF) defines left ventricular (LV) systolic dysfunction and is associated with poor prognosis. However, CKD patients may have HF symptoms with preserved LVEF. In this subgroup of patients, two‐dimensional speckle tracking echocardiography can detect LV systolic dysfunction by analysing LV myocardial deformation. The present study evaluated the prevalence of impaired LV global longitudinal strain (GLS) in CKD patients with preserved LVEF and its prognostic consequences.

Methods and results

Overall, 200 pre‐dialysis and dialysis patients (65% men, mean age 60 ± 14 years) with CKD stage 3b–5 and preserved LVEF (≥50%) were evaluated. Left ventricular systolic dysfunction despite preserved LVEF was defined by LV GLS ≤15.2% (cut‐off value derived from two standard deviations below the mean value of individuals without structural heart disease). Impaired LV GLS (≤15.2%) despite preserved LVEF was observed in 32% of patients. During a median follow‐up of 33 months (interquartile range 17–62 months), 47% of patients underwent renal transplantation, 9% were admitted with HF, and 28% died. Patients with LV GLS ≤15.2% showed significantly worse cumulative event‐free survival rates of the combined endpoint of HF hospitalization and all‐cause mortality compared to patients with LV GLS >15.2% (log‐rank P = 0.018).

Conclusion

The prevalence of impaired LV GLS despite preserved LVEF in pre‐dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all‐cause mortality.

     

Coronary artery bypass grafting in patients with severe left ventricular dysfunction: predictive significance of left ventricular diastolic filling pattern.

AIMS: The aim of our study was to evaluate the influence of left ventricular (LV) diastolic filling impairment on postoperative results in patients (pts) with low LV ejection fraction (EF) (<35%) undergoing coronary artery bypass grafting (CABG). METHODS: The study covered 56 patients (mean age 58.9 +/- 17.1 years). Two dimensional Doppler echocardiographic investigations were performed pre- and 10-14 days post-CABG. Patients were divided into three groups according to the LV diastolic filling. RESULTS: Early postoperative mortality rate (including perioperative period and 2 weeks after surgery) was highest in the restriction group (33%) vs. pseudonormalization (12.5%) vs. impaired relaxation (13.6%). Postoperative cardiovascular complications rate was highest also in the restriction group, 55.5%, and did not differ between pseudonormalization (25%) and impaired relaxation group (27.2%). Logistic regression analysis showed that restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter independently influence perioperative mortality. In the early postoperative period mean LV wall motion score (WMS) did not improve in 8/19 (42%), 6/14 (43%) and 8/12 (67%) patients, respectively, in the impaired relaxation, pseudonormalization and restriction group. CONCLUSIONS:In patients with severe LV dysfunction undergoing CABG, impaired relaxation and pseudonormal pattern of LV diastolic filling correlated with postoperative improvement in LV regional contraction, while restrictive pattern correlated with high early postoperative mortality, morbidity and minimal improvement in LV systolic function. Restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter were found to be independent predictors of perioperative mortality.     

The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission

Background and Objective: The CRB65 score, a risk stratification method validated for use in community‐acquired pneumonia, has recently been shown to have utility in acute exacerbations of COPD (AECOPD). The objective of this study was to independently validate the CRB65 score as a predictor of mortality in patients who required hospital admission with AECOPD. Methods: The medical records of patients admitted to Wellington Hospital with AECOPD during a 12‐month period from June 2006 were reviewed. Logistic regression was used to determine the strength of the association between the CRB65 score and death at three measurement times: in‐hospital, 30 days and 12 months. Results: Complete data were available in 133/174 patient admissions. In‐hospital and 30‐day mortality increased progressively with increasing CRB65 score and was markedly higher in the CRB 3–4 group (3%, 5%, 29%, and 4%, 9%, 43% for CRB65 scores 0–1, 2, 3–4 for in‐hospital and 30‐day mortality, respectively). Differences in 1‐year mortality were less apparent (24%, 25%, 57% for CRB65 scores 0–1, 2, 3–4, respectively). The CRB65 score demonstrated a modest value for predicting in‐hospital and 30‐day mortality with a c statistic of 0.68 at both time points. Conclusions: The CRB65 score shows similar characteristics for predicting short‐term mortality in AECOPD as its use in community‐acquired pneumonia. We recommend its use in clinical practice, particularly in patients with a score ≥3, which is associated with a high risk of early mortality, and need for intensive hospital management.     

Effect of early pulmonary rehabilitation on health care utilization and health status in patients hospitalized with acute exacerbations of COPD

Background and objective: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) incur heavy utilization of health‐care resources for patients who require hospitalization. We evaluated whether an early outpatient pulmonary rehabilitation programme (PRP) after hospitalization for AECOPD could reduce acute health‐care utilization over the succeeding year. Methods: Sixty patients admitted with AECOPD were randomized to either PRP or usual care (UC). The PRP group received 8 weeks of outpatient rehabilitation programme 2–3 weeks after discharge from hospital. Lung function, 6 min walk test and dyspnoea score were assessed at baseline, 3, 6, 9 and 12 months, while St George's respiratory questionnaire and cardiopulmonary exercise test were assessed at baseline, 3, 6 and 12 months. Results: The PRP and UC groups demonstrated a 53.3% and 43.3% risk of readmissions at 12 months (incident risk ratio 0.97 (95% CI: 0.57–1.60), P = 0.90). The mean readmission rates were 1.00 ± 1.20 and 1.03 ± 1.87 (P = 0.47) for the PRP versus UC groups respectively. The rates of AECOPD and emergency department visits were similar between the two groups. The St George's respiratory questionnaire total score was lower in the PRP group (40.15 ± 19.10 vs 46.91 ± 18.21, P = 0.01 and 42.3 ± 20.06 vs 51.44 ± 18.98 P = 0.01 at 3 and 6 months respectively). There were no statistically significant differences in the FEV₁% predicted, dyspnoea score, 6 min walk test and maximal oxygen consumption during exercise test between PRP and UC at different time points. Conclusions: An early rehabilitation programme following AECOPD led to improvement in quality of life up to 6 months, but did not reduce health‐care utilization at 1 year.     

Long-term significance of Killip class and left ventricular systolic dysfunction

Background

Killip classification is an independent predictor of early mortality after myocardial infarction, and the presence of left ventricular systolic dysfunction (left ventricular ejection fraction <50%) and high Killip class predicts poor short-term prognosis. The long-term prognostic significance of Killip class and left ventricular systolic dysfunction, however, is unknown.

Methods

We studied the impact of Killip class and left ventricular systolic dysfunction on all-cause mortality (assessed in May 2007 using the Social Security Death Index) in myocardial infarction patients admitted from July 1995 to December 1996.

Results

Of 282 patients, 60% (n = 168) were Killip class 1, 23% (n = 64) were Killip class 2, and 17% (n = 50) were Killip class 3 or 4. Patients with higher Killip class were older and more likely to have diabetes, a non-Q-wave myocardial infarction, renal insufficiency, chronic obstructive pulmonary disease, and left ventricular systolic dysfunction. There were 152 deaths at 10 years after myocardial infarction, and patients with Killip class 2, 3, or 4 had higher mortality compared with Killip class 1 in unadjusted analyses. Patients with left ventricular systolic dysfunction and Killip class of 2 or more had significantly higher 10-year mortality (70 deaths or 76.9%) compared with Killip class 1 patients without left ventricular systolic dysfunction (29 deaths or 34.5%, P <.001). This risk persisted after adjusting for demographics, cardiovascular risk factors, and co-morbidities. Much of the risk was explained by deaths in the first 5 years after myocardial infarction.

Conclusions

Killip class is a strong predictor of long-term mortality, and patients with high Killip class and left ventricular systolic dysfunction are at highest risk.     

COPD患者合并医院感染50例临床分析

目的探讨COPD患者合并医院感染的临床特点及防治措施。方法对50例COPD患者医院感染情况进行回顾性分析。结果医院感染率为20．3％,病死率为26％,明显高于COPD患者非医院感染的病死率（P〈0．01）。感染部位以下呼吸道为主（78％）,其次为上呼吸道、泌尿道、胃肠道等。感染发生率与住院时间成正比。感染与长期连用多种抗生素有关。结论COPD患者医院感染发生率及病死率较高,在积极治疗基础疾病的同时,应合理使用抗生素,缩短住院时间,减少医院感染的发生。