慢性阻塞性肺疾病急性加重患者频繁再入院与其危险因素

目的　评价慢性阻塞性肺疾病 (COPD)患者急性加重频繁入院的危险因素。方法　调查两家大型医院因COPD急性加重入院的 196名中重度COPD患者。在患者出院时和出院后一个月稳定状态 ,收集患者的临床性状、社会性状、日常护理因素和过去一年中急性加重入院的频率 ,测定肺功能指标及精神状态。结果　 196例COPD患者中 ,72 %过去一年中有一次以上再入院 ,4 8%有 2次以上 ,8%有超过 10次再入院。单变量分析显示男性、病程长、嗜用镇痛剂和安眠药、第 1秒用力呼气容量占预计值的百分比 (FEV1% ) <4 5 %、缺乏肺康复训练和严重气促与频繁再入院有显著相关性 (P <0 .0 5 )。多变量分析显示病程长 (OR =2 .6 0 )、FEV1% <4 5 % (OR =2 .0 3)、严重气促 (OR =2 .5 0 )和男性 (OR =3.13)与COPD急性加重再入院有独立显著相关性 (P <0 .0 5 )。结论　COPD急性加重频繁再入院与COPD严重程度、患者精神抑郁状态及照料这些可改善因素有关

Frequent Hospital Readmissions duo to Acute Exacerbation of COPD and their Associated Factors

Objective To ascertain rates of hospitalizations duo to acute exacerbations of COPD patients (AECOPD) and evaluate the association of risk factors with frequent admissions for acute exacerbations.Methods A study sample of 196 patients with moderate to severe COPD admitted for acute exacerbations to two large general hospitals were studied.Frequency of previous readmissions duo to COPD,socio-demographic,clinical and patient care characteristics,including depression and spirometry were ascertained in the stable state before discharge and after one-month discharge.Results Among the patients,72% had at least one previous readmission,48% had two or more,8% had more than 10 to 20 readmissions in the one year period prior to current admission. Univariate analysis showed that male gender,receipt of pulmonary rehabilitation,duration≥5yrs,FEV 1%<45% predicted,use of psychotropic drugs and severer dyspnea were significantly associated with frequent readmissions.Multivariate analysis showed that disease duration≥5yrs (OR=2.60),FEV 1%<45% predicted (OR=2.03),severer dyspnea (OR=2.50) and males (OR=3.13) were independently related to the risk of readmission for acute exacerbations.Conclusion Readmission duo to COPD exacerbation is associated with disease severity,psychosocial and health care factors that are modifiable.