慢性阻塞性肺疾病合并呼吸衰竭呼吸监护病房再入院患者临床分析

目的：探讨呼吸重症监护室（RICU）慢性阻塞性肺疾病（COPD）合并呼吸衰竭1年再住院患者预后及影响因素。方法2008年1月至2013年10月收入RICU的COPD合并2型呼吸衰竭患者，随访1年，记录患者临床资料及预后，分析再入院影响因素。结果①再住院患者病死率（44.8％）显著高于非再住院患者（χ2＝9.472， P ＜0.05）。②与非再住院组相比，再住院组脑尿钠肽（brain natriuretic peptide ，BNP）增高、收住RICU未能早期控制、病情稳定后仍存在高碳酸血症患者增加（χ2分别为6.306、4.463、9.635，P值均＜0.05）③以RICU患者再住院与否为因变量，进行二分类Logistic回归分析，结果显示：Nagelkerke＝0.705，BNP增高、病情未早期控制、入院血氧分压减低和稳定期存在高碳酸血症是患者再入院增加的独立危险因素。结论收住RICU的COPD合并2型呼吸衰竭的再住院患者，病死率增加。入院时血氧分压减低、合并BNP增高、病情未能早期控制和稳定期存在高碳酸血症患者再入院危险增加，应加强院外随访与护理指导，降低再住院率，改善预后。

Clinical analysis of readmission patients with COPD complicated with respiratory failure in RICU

Objective To investigate one year prognosis and prognostic factors of readmission patients with chronic obstructive pulmonary disease ( COPD ) complicated with respiratory failure in RICU .Methods Readmission patients with COPD combined with respiratory failure type 2 income RICU between January 2008 to October 2013 ,follow‐up of one year ,recording the clinical data and prognosis , analysis of influencing factors .Results ① The mortality rate of readmission patients ( 44 .8% ) was significantly higher than that of non readmission patients ( χ2 =9 .472 , P <0 .05) .②Compared with the non readmission group ,BNP increased ,admission to the RICU failed to early control ,with hypercapnia on stable condition there is increased in patients of readmission group ( χ2 values were 6 .306 ,4 .463 ,9 .635 , all P < 0 .05 ) .③ Rehospitalization and not as dependent variable , regression analysis , two Logistic classification results showed that :Nagelkerke R2 = 0 .705 ,BNP increased ,the condition is not early admission control ,partial pressure of oxygen reduction and stable stage presence of hypercapnia are independent risk factors for patient readmission increase .Conclusions Mortality rate of admission patients with COPD and type 2 respiratory failure in RICU increased .Partial pressure of oxygen reduction , complicated with BNP increased ,the disease failed to early control and stable period have hypercapnia in patients with increased risk of readmission ,should strengthen follow‐up and nursing guidance outside the hospital ,reduce the rehospitalization rate ,improve prognosis .