与慢性阻塞性肺部疾病恶化的住院患者初始治疗失败相关的因素:一个队列研究
Noriko Kohyama1, Kuniaki Hirai2, Hironori Sagara2
1Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa Medical University School of Pharmacy, Tokyo, Japan.
概括
鉴定慢性阻塞性肺病 (ECOPD) 恶化的治疗失败高风险患者至关重要. 家庭氧气治疗,高中性粒细胞计数和酸性血症是ECOPD患者治疗失败的关键指标.
科学领域:
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
- 内部医学 内部医学
背景情况:
- 慢性阻塞性肺病 (ECOPD) 的恶化可能导致治疗失败,需要改变抗微生物治疗或先进干预措施.
- 早期识别高风险治疗失败的患者对于优化管理策略至关重要.
研究的目的:
- 为了调查与初始治疗失败相关的因素,在经历了ECOPD的患者.
- 确定可帮助临床医生预测和有效管理治疗失败的预测因素.
主要方法:
- 进行了一项队列研究,涉及住院患有ECOPD的患者.
- 最初的治疗失败被定义为综合结果,包括治疗强化和住院死亡率.
- 使用单变量和多变量分析来确定与治疗失败相关的因素.
主要成果:
- 这项研究包括152名ECOPD患者 (平均年龄为76±8岁,81%为男性).
- 治疗失败发生在26名 (17%) 患者中,包括抗微生物药物变化,需要通风支持和死亡率.
- 多变量分析确定了家庭氧气疗法 (OR,5.335),中性粒细胞数≥7000细胞/μL (OR,3.550) 和酸性血 (OR,3.129) 作为治疗失败的重要预测因素.
- 接受家庭氧气治疗的患者在接受窄谱抗生素治疗时,治疗失败率更高.
结论:
- 家庭氧气疗法,中性粒细胞数量升高,以及入院时的酸性血症是导致ECOPD治疗失败的重要风险因素.
- 家庭氧气疗法和狭窄谱抗生素的结合造成治疗失败的风险特别高.
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