某三甲医院慢性阻塞性肺疾病患者出院1年内再入院情况及影响因素分析

刘莹; 徐蕾; 毕薇; 孟囡囡

doi:10.16766/j.cnki.issn.1674-4152.002814

某三甲医院慢性阻塞性肺疾病患者出院1年内再入院情况及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002814

刘莹^1, ,,
徐蕾¹,
毕薇¹,
孟囡囡²

1.
同济大学附属第十人民医院上海市第十人民医院呼吸与危重症医学科, 上海 200072
2.
上海市杨浦区中医医院肺病科, 上海 200082

基金项目:

上海市卫生和计划生育委员会中医药科研项目 2018LP043

详细信息

通讯作者:
刘莹，E-mail：aomoxian@163.com

中图分类号: R563
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-29
- 网络出版日期: 2023-04-07

Readmission and influencing factors of patients with chronic obstructive pulmonary disease within 1 year after discharge in a Class Ⅲ Grade A hospital

LIU Ying^{1
, ,},
XU Lei¹,
BI Wei¹,
MENG Nan-nan²

1.
Department of Respiratory and Critical Care Medicine, Shanghai Tenth People ' s Hospital, Shanghai 200072, China

摘要

摘要: 目的调查慢性阻塞性肺疾病(COPD)急性加重患者出院后1年内再入院状况，并分析其影响因素。方法选取上海市第十人民医院2019年2月—2020年8月收治的COPD急性加重期患者208例为研究对象，对患者出院后1年内进行随访，调查其是否再入院，并根据患者是否再入院分为再入院组(82例)和非再入院组(126例)，采用logistic回归分析研究影响患者再入院的相关因素。结果患者出院后1年内再入院共82例(39.42%)，其中再入院次数为1次者共58例(27.88%)，再入院次数≥2次者共24例(11.54%)。2组在年龄、吸烟指数、高血压、冠心病、中低强度日均活动时间、前1年内急性加重次数、家庭氧疗、规律服药、第一秒用力呼吸容积占预计值百分比(FEV₁%Pred)、家庭照顾能力等方面比较差异有统计学意义(均P＜0.05)。多因素logistic回归分析显示中低强度日均活动时间(＜2 h)、FEV₁%Pred＜50%、前1年内急性加重次数≥2次、家庭照顾能力下降是影响COPD急性加重患者再入院的独立危险因素。1年内1次再入院组与≥2次再入院组患者在年龄、中低强度日均活动时间、前1年内急性加重次数、FEV₁%Pred、家庭照顾能力指标等方面比较差异有统计学意义(均P＜0.05)。结论 COPD急性加重患者出院后1年内再入院率较高，中低强度日均活动时间、FEV₁%Pred、前1年内急性加重次数、家庭照顾能力是患者再入院的影响因素。
- 慢性阻塞性肺疾病 /
- 急性加重 /
- 再入院 /
- 影响因素
Abstract: Objective To investigate the readmission status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) within 1 year after discharge and analyse its influencing factors. Methods A total of 208 patients with acute exacerbation of COPD who were admitted to our hospital from February 2019 to August 2020 were selected as the research objects. The patients were followed up within 1 year after discharge to investigate whether they were readmitted. Based on whether the patients were readmitted, they were divided into readmitted group (82 cases) and non-readmitted group (126 cases). Results A total of 82 patients (39.42%) were readmitted within 1 year after discharge, of which 58 (27.88%) were readmitted once and 24 patients (11.54%) were readmitted two times or more. The two groups had statistically significant differences in age, smoking index, hypertension, coronary heart disease, average daily activity time of medium and low intensity, the number of acute exacerbations in the previous year, home oxygen therapy, regular medication, percentage of the volume of forced breathing in the first second predicted (FEV₁%Pred) and family care ability (all P < 0.05). Multivariate logistic regression analysis showed that moderate-to-low intensity daily activity time (< 2 h), FEV₁%Pred (< 50%), number of acute exacerbations in the previous year (≥2 times) and decreased family care ability were independent risk factors for readmission of COPD patients with acute exacerbations. There were statistically significant differences in age, average daily activity time of medium and low intensity, number of acute exacerbations in the previous year, FEV₁%Pred, and family care ability between the patients who were readmitted once in a year and those who were readmitted more than twice in a year (all P < 0.05). Conclusion The readmission rate of patients with acute exacerbation of COPD within 1 year after discharge is high. Moderate-to-low-intensity daily activity time, FEV₁%Pred, the number of acute exacerbations in the previous year and family care ability are independent risk factors for readmission.
- Chronic obstructive pulmonary disease /
- Acute exacerbation /
- Readmission /
- Influencing factors

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表 1 2组COPD急性加重患者相关临床资料单因素分析

Table 1. Univariate analysis of clinical data between the two groups

项目	再入院组(n=82)	非再入院组(n=126)	统计量	P值
性别[例(%)]			0.065^a	0.799
男性	65(79.27)	98(77.78)
女性	17(20.73)	28(22.22)
年龄(x±s，岁)	72.92±2.82	71.78±2.79	2.868^b	0.005
吸烟指数(x±s，支/年)	765.86±78.25	732.75±86.81	2.793^b	0.006
高血压[例(%)]			4.880^a	0.027
有	55(67.07)	65(51.59)
无	27(32.93)	61(48.41)
冠心病[例(%)]			8.904^a	0.003
有	25(30.49)	17(13.49)
无	57(69.51)	109(86.51)
糖尿病[例(%)]			0.550^a	0.458
有	17(20.73)	21(16.67)
无	65(79.27)	105(83.33)
抗生素使用时间(x±s，d)	11.72±1.79	10.45±1.65	1.115^b	0.266
中低强度日均活动时间[例(%)]			18.091^a	＜0.001
≥2 h	28(34.15)	81(64.29)
＜2 h	54(65.85)	45(35.71)
前1年内急性加重次数[例(%)]			14.938^a	＜0.001
≥2次	27(32.93)	14(11.11)
＜2次	55(67.07)	112(88.89)
家庭氧疗[例(%)]			4.403^a	0.036
是	34(41.46)	71(56.35)
否	48(58.54)	55(43.65)
规律服药[例(%)]			7.294^a	0.007
是	63(76.83)	114(90.48)
否	19(23.17)	12(9.52)
FEV₁%Pred[例(%)]			9.752^a	0.002
≥50%	9(10.98)	37(29.37)
＜50%	73(89.02)	89(70.63)
家庭照顾能力(x±s，分)	11.58±2.63	8.95±2.68	6.967^b	＜0.001
注：^a为χ²值，^b为t值。

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表 2 1年内1次再入院组与≥2次组患者临床资料比较

Table 2. Comparison of clinical data between the readmission group and the readmission group ≥2 times within 1 year

项目	1次入院组(n=58)	≥2次入院组(n=24)	统计量	P值
性别[例(%)]			0.064^a	0.801
男性	45(77.59)	18(75.00)
女性	13(22.41)	6(25.00)
年龄(x±s，岁)	72.39±2.61	73.85±2.73	2.274^b	0.026
吸烟指数(x±s，支/年)	769.85±81.68	763.52±88.43	0.312^b	0.756
高血压[例(%)]			0.217^a	0.641
有	38(65.52)	17(70.83)
无	20(34.48)	7(29.17)
冠心病[例(%)]			0.130^a	0.719
有	17(29.31)	8(33.33)
无	41(70.69)	16(66.67)
糖尿病[例(%)]			0.376^a	0.540
有	11(18.97)	6(25.00)
无	47(81.03)	18(75.00)
抗生素时间使用(x±s，d)	11.69±1.81	11.75±1.76	0.138^b	0.891
中低强度日均活动时间[例(%)]			4.610^a	0.032
≥2 h	24(41.38)	4(16.67)
＜2 h	34(58.62)	20(83.33)
前1年内急性加重次数[例(%)]			4.478^a	0.034
≥2次	15(25.86)	12(50.00)
＜2次	43(74.14)	12(50.00)
家庭氧疗[例(%)]			0.267^a	0.605
是	23(39.66)	11(45.83)
否	35(60.34)	13(54.17)
规律服药[例(%)]			0.104^a	0.747
是	44(75.86)	19(79.17)
否	14(24.14)	5(20.83)
FEV₁%Pred[例(%)]			4.183^a	0.041
≥50%	9(15.52)	0
＜50%	49(84.48)	24(100.00)
家庭照顾能力(x±s，分)	10.61±2.15	11.93±2.81	-2.306^b	0.024

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表 3 分类变量赋值表

Table 3. Categorical variable assignment

变量	赋值方法
年龄	以实际值赋值
吸烟指数	以实际值赋值
高血压	无=0，有=1
冠心病	无=0，有=1
中低强度日均活动时间	＜2 h=0，≥2 h=1
前1年内急性加重次数	＜2次=0，≥2次=1
家庭氧疗	否=0，是=1
规律服药	否=0，是=1
FEV₁%Pred	＜50%=0，≥50%=1
家庭照顾能力	以实际值赋值
再入院	否=0，是=1

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表 4 影响COPD急性加重患者出院后1年内再入院的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of readmission in patients with acute exacerbation of COPD within 1 year after discharge

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.283	0.162	3.483	0.062	1.327	0.966~1.823
吸烟指数	0.279	0.158	3.412	0.065	1.322	0.970~1.801
高血压	0.213	0.132	3.014	0.083	1.237	0.955~1.603
冠心病	0.259	0.143	3.396	0.065	1.296	0.979~1.715
中低强度日均活动时间	1.465	0.689	12.857	＜0.001	4.327	1.121~16.696
前1年内急性加重次数	1.392	0.645	11.459	＜0.001	4.022	1.136~14.238
家庭氧疗	-0.205	0.118	2.979	0.084	0.815	0.646~1.027
规律服药	-0.198	0.105	3.285	0.070	0.820	0.668~1.008
FEV₁%Pred	1.065	0.495	8.695	0.003	2.901	1.099~7.652
家庭照顾能力	1.235	0.589	9.599	0.002	3.438	1.084~10.905

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