COPD患者30天内再住院影响因素及死亡情况分析

发布时间：2018-03-07 16:09

本文选题：慢性阻塞性肺病　切入点：30天再住院　出处：《新疆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨慢性阻塞性肺病患者30天内再住院可能的影响因素及其预后,为慢性阻塞性肺病急性加重的预防或治疗提供依据。方法:收集2012年1月-2014年12月新疆医科大学属中医医院呼吸科住院并在出院后30天内因急性加重再次住院的慢性阻塞性肺病患者,同时收集病情严重程度相同未发生30天内再住院的慢性阻塞性肺病患者作为对照。通过收集患者住院期间的病例资料,找出可能与COPD患者出院后30天内发生再入院相关的影响因素。结果:收集观察组176例患者,对照组150例,两组之间患者年龄、性别、病史、病程及疾病严重程度不存在显著差异性;统计发现观察组与对照组之间在三代加酶和喹诺酮药物使用频次未见明显差异,无统计学意义(P0.01)。而在碳青霉烯类药物使用频次上观察组明显高于对照组有显著差异,且有统计学意义(2?=24.34,P0.01);统计发现观察组与对照组在住院期间吸入激素的使用情况无明显差异,无统计学意义(P0.01);观察组使用全身激素的频率明显高于对照组,有统计学意义(2?=14.14,P0.01);COPD患者出院后药物使用情况统计分析发现,观察组患者出院后未遵医嘱服药的比例明显高于对照组患者,且存在明显差异,有统计学意义(P0.01)。观察组中COPD患者合并症中以心血管疾病较多,依次是糖尿病和支气管哮喘;对比发现合并症数量小于3种时,对照组合并症小于3的人数明显多于观察组,存在显著差异,有统计学意义(P0.01);当合并症数量大于等于3时,观察组合并症大于3的人数明显多于对照组,存在明显差异,有统计学意义(2?=25.97,P0.01);对两组COPD患者进行跟踪随访,观察组中2年内死亡的患者有50人(28%),对照组中2年内死亡有17人(11%),观察组COPD患者2年内死亡率显著高于对照组,两组之间差异明显,有统计学意义(2?=13.38,P0.01)。结论:COPD患者30天内再住院的发生可能与患者前一次住院期间治疗(激素治疗、抗生素治疗),自身的合并症管理,出院后的药物依从性相关。同时两组患者的中医的辨证型以痰浊壅肺证及燥邪伤肺证多见。发生30天再住院的COPD患者2年死亡率较未发生再住院的患者有显著升高。提示在临床诊疗工作中应当重视COPD患者30天再住院的发生。COPD患者30天内再次发生急性加重对判断CODP患者的预后具有重要的意义。
[Abstract]:Objective: To investigate the 30 day readmission may influence factors and prognosis of patients with chronic obstructive pulmonary disease, provide the basis for the prevention or treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods: from January 2012 December -2014 Xinjiang Medical University is a Chinese Medicine Hospital Department of respiration and hospital in the hospital within 30 days of acute exacerbation of readmission in patients with chronic obstructive pulmonary disease at the same time, collecting the same severity did not occur within 30 days in patients with chronic obstructive pulmonary disease patients as control. Through collecting the patients during hospitalization were collected, and find out the possible factors associated with readmission within 30 days after discharge in patients with COPD. Results: collected 176 patients in the observation group, 150 cases in the control group. Between the two groups of patients with age, gender, history, course of disease and the severity of the disease does not exist significant differences; statistics found between observation group and control group in the three generation plus The use of enzymes and frequency of quinolone drugs showed no significant difference, no statistical significance (P0.01). The frequency of carbapenem use was higher in the observation group were significantly different, with statistical significance (2? =24.34, P0.01); statistics found that the observation group and the control group in the use of hormone inhalation during hospitalization no significant difference was not statistically significant (P0.01); the observation group used systemic hormone frequency was significantly higher than the control group, there was statistical significance (2? =14.14, P0.01); COPD patients discharged from hospital after drug use statistical analysis found that the patients in the observation group were discharged without medication was significantly higher than that in control group, and there significant difference was statistically significant (P0.01). The observation group COPD patients in order to complications of cardiovascular disease are more, diabetes and asthma; comparison of comorbidity number is less than 3, and the control group In less than 3 of the population were significantly more than the observation group, there were significant differences, with statistical significance (P0.01); when the number of comorbidities is greater than or equal to 3, and in more than 3 of the observation group was significantly less than the number of control group, there is significant difference, with statistical significance (2? =25.97, P0.01); the two groups of patients with COPD within 2 years of follow-up, death in the observation group with 50 patients (28%), the control group died within 2 years 17 people (11%), the observation group of COPD patients within 2 year mortality was significantly higher than the control group, the difference between the two groups was statistically significant (2? = 13.38, P0.01). Conclusion: COPD patients within 30 days of hospitalization patients may be associated with previous treatment during hospitalization (hormone therapy, antibiotic treatment), complications of the management of their own, after discharge related drug compliance. At the same time, the two groups of patients with TCM syndrome differentiation type of phlegm syndrome and Zaoxieshangfei syndrome see 30 days to live. The 2 year mortality rate of COPD patients in the hospital is significantly higher than that of the non rehospitalized patients. It suggests that in the clinical diagnosis and treatment work, we should pay attention to the occurrence of COPD patients' rehospitalization within 30 days. The occurrence of acute exacerbation within 30 days of.COPD patients is of great significance for the prognosis of CODP patients.

【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.9

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