COPD急性加重时影响病死率危险因素的回顾性病例对照研究.docVIP

COPD急性加重时影响病死率危险因素的回顾性病例对照研究 刘双林，李 琦，吴学玲，徐 智，王长征（第三军医大学新桥医院呼吸内科，重庆400037） 摘 要： 目的　探讨影响慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD) 病死率的危险因素。方法　选择我科2004 年1月至2008年6月因慢性阻塞性肺病急性加重（acute exacerbation of chronic obstructive pulmonary disease ，AECOPD）病死的33例患者，及同期缓解出院的40例AECOPD患者为对照进行回顾性分析，研究影响其预后的危险因素。结果　死亡组和对照组的一般情况大致相似，而且两组在氧合指数、发生酸碱失衡的病例数等方面也没有显著差异。在住院期间的最高PaCO2的水平以及使用机械通气、发生肺性脑病、消化道出血、肾功能衰竭、多器官功能不全的病例数等方面则有显著差异。经多重Logistic回归分析,消化道出血（OR值13.09，95%IC1.06－162.18）、无创(OR值9.19 ,95%IC2.15－39.42)或有创机械通气(OR值11.055; 95%IC1.91－ 63.94)是预计AECOPD 病死率的独立危险因素。由于对照组没有并发肾功能衰竭、多器官功能不全、弥漫性血管内凝血的病例，所以没进行多重回归分析。结论 AECOPD时的低氧血症、酸碱失衡不是影响其病死率的重要危险因素。而合并多器官功能不全、肾功能衰竭、消化道出血等并发症以及需要机械通气治疗则是提示预后不良的重要指标。 关键词：慢性阻塞性肺疾病；病死率；危险因素；多重Logistic回归 中图法分类号： 文献标识码：A The risk factors impacting on the mortality of acute exacerbation of COPD：a retrospective case control study huang-lin, LI Qi, WU Xue-ling, XU Zhi, WANG Chang-zheng(Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037) Abstract: Objective To explore the risk factors impacting on the mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Method 33 patients who died of AECOPD and 40 discharged patients with AECOPD were analyzed retrospectively for the risk factors of prognosis. Results The demographic characteristics of patients in the both groups are approximately similar; moreover there are not significant differences in oxygenation index, the number of the cases with acid-base imbalance between the two groups. But there are significant differences in the highest PaCO2 level　in the hospital and the number of the cases using mechanical ventilation，being with pulmonary encephalopathy, renal failure ,alimentary tract hemorrhage and MODS. By the multiple Logistic regression analysis, the alimentary tract hemorrhage (the OR value 13.09, 95%IC 1.06-162.18), no-invasive (the OR value 9.19, 95%IC 2.15- 39.42) or invasive ventilation (the OR value 11.055; 95%