摘要
目的探讨影响慢性阻塞性肺疾病急性加重(AECOPD)合并二氧化碳(CO2)潴留患者应用全身糖皮质激素的相关因素,指导制定减少全身糖皮质激素暴露的策略.方法选择2017年1月至2019年12月福建医科大学附属宁德市医院收治的AECOPD合并CO2潴留患者作为研究对象.收集患者一般资料、既往史、1年内急性加重次数,入院时有无肺炎、诱发COPD原因、是否合并心力衰竭、血气分析及血清嗜酸粒细胞计数(EOS)、白蛋白(Alb)和载脂蛋白E(ApoE)水平,以及急性加重期呼出气一氧化氮(FeNO)水平、接受雾化吸入糖皮质激素和无创机械通气治疗情况.根据住院期间患者累计全身糖皮质激素暴露情况分为推荐剂量组(暴露水平在推荐剂量范围内,泼尼松累计剂量≤200 mg)和超量组(暴露水平超过推荐剂量,泼尼松累计剂量>200 mg).比较两组患者的临床资料,并将单因素分析中P<0.1的可能相关因素纳入多因素Logistic回归分析,筛选影响AECOPD合并CO2潴留患者全身糖皮质激素暴露水平的相关因素.结果按研究对象入院顺序连续入选151例AECOPD合并CO2潴留患者,排除8例,最终共143例患者纳入分析.143例患者中,68例接受了推荐剂量全身糖皮质激素,75例接受了超量全身糖皮质激素;两组患者年龄、稳定期1秒用力呼气容积占预计值百分比(FEV1%)、1年内急性加重次数、合并心力衰竭比例,入院时氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)、血清EOS和ApoE水平,以及急性加重期接受雾化吸入糖皮质激素和无创机械通气治疗比例差异均有统计学意义.多因素Logistic回归分析显示,稳定期FEV1%〔优势比(OR)=0.957,95%可信区间(95%CI)为0.921~0.994,P=0.023〕、1年内急性加重次数(OR=1.530,95%CI为1.121~2.088,P=0.007)、合并心力衰竭(OR=3.022,95%CI为1.263~7.231,P=0.013)、入院时PaCO2(OR=1.062,95%CI为1.010~1.115,P=0.018)和EOS水平(OR=0.103,95%CI为0.016~0.684,P=0.019)以及�
Objective To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with carbon dioxide(CO2)retention,and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure.Methods The AECOPD patients with CO2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled.The general information,past history,times of acute exacerbations within 1 year,pneumonia on admission,causes of COPD,heart failure,blood gas analysis,eosinophil count(EOS),albumin(Alb)and apolipoprotein E(ApoE)levels,exhaled nitric oxide(FeNO)level,inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected.The patients were divided into recommended dosage group(exposure levels in the recommended dosage range,cumulative prednisone dosage≤200 mg)and exceeded group(exposure levels exceeded the recommended dose,cumulative prednisone dosage>200 mg)according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization.The clinical data of patients between the two groups were compared,and possible factors with P<0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO2 retention.Results According to the order of hospitalization,151 AECOPD patients with CO2 retention were enrolled,8 patients were excluded,and 143 patients were enrolled in the analysis.Of the 143 patients,68 received the recommended dose of systemic glucocorticoid,and 75 received excessive systemic glucocorticoid.Age,percentage of forced expiratory volume in 1 second(FEV1%)at stable phase,frequency of acute exacerbation within 1 year,heart failure ratio,oxygen index(PaO2/FiO2),arterial partial pressure of carbon dioxide(PaCO2),serum EOS and ApoE levels at admission,the ratio of aerosolized in
作者
焦维克
张文
张灿辉
刘志新
甘玉燕
彭志文
严刚
邓新宇
薛青
吴建辉
Jiao Weike;Zhang Wen;Zhang Canhui;Liu Zhixin;Gan Yuyan;Peng Zhiwen;Yan Gang;Deng Xinyu;Xue Qing;Wu Jianhui(Department of Pulmonary and Critical Care Medicine,Ningde Municipal Hospital of Fujian Medical University(Ningde Municipal Hospital of Ningde Normal University),Ningde 352100,Fujian,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第9期1061-1066,共6页
Chinese Critical Care Medicine
基金
福建省自然科学基金(2018J01228)
福建省卫生计生青年科研课题项目(2017-2-95)
福建省宁德市医技提升科研项目(2109901)。
关键词
慢性阻塞性肺疾病
急性加重
二氧化碳潴留
全身糖皮质激素
相关因素
无创机械通气
Chronic obstructive pulmonary disease
Acute exacerbation
Carbon dioxide retention
Systemic glucocorticoids
Related factor
Non-invasive mechanical ventilation
