衰弱对慢性阻塞性肺疾病急性发作再住院的影响
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摘要
目的通过分析老年医院呼吸科慢性阻塞性肺疾病(COPD)住院患者的临床资料、衰弱和再次因慢性阻塞性肺疾病急性发作(AECOPD)住院的情况,探讨老年患者衰弱与再次因AECOPD住院之间的关系。方法纳入2015年9月1日至2018年10月31日就诊于北京老年医院呼吸科的老年慢性阻塞性肺疾病住院患者117例。衰弱的诊断采用临床衰弱评分(CFS),在出院24时内进行评估,并据此将患者分为衰弱组和非衰弱组。收集患者入院时一般临床资料、疾病史、共病数量、用药情况等,对所有患者进行3个月AECOPD再住院情况随访。结果依据CFS评估结果,将117例患者分为两组:衰弱组(n=53,45.3%)和非衰弱组(n=64,54.7%)。与非衰弱组比较,衰弱组患者年龄偏大、心功能不全、脑梗死的比例增高(P<0.05),衰弱组共病数量(≥4)、服药品种数量(>5)多、COPD等级高。非衰弱组3个月内再次出现AECOPD住院6例(9.4%),对比衰弱组45例(84.9%),两组差异有统计学意义(P<0.05)。通过二元logistic回归分析,发现衰弱对再次AECOPD住院影响最大(OR值=35.247,95%CI=10.57～117.527,P<0.05)。结论衰弱的老年人有更高的风险在3个月内再次因AECOPD住院。
Objective To analyze of the clinical data of inpatients with COPD from Respiratory Department of Geriatric Hospital, and hospitalization survey on AECOPD and frailty, and to study the relationship between frailty and rehospitalized for AECOPD in elderly patients.Methods A total of 117 inpatients with AECOPD from September 1,2015 to October 31,2018 were prospectively recruited in this study. Diagnosis of frailty was evaluated with CFS within 24 hours of discharge, and then they were assigned into the frailty group and non-frailty group. General clinical data, disease history, number of comorbidities and drug use were collected. All patients were followed up for 3 months for AECOPD re-hospitalization.Results According to CFS evaluation results, 117 patients were divided into two groups, frailty group(n=53, 45.3%) and non-frailty group(n=64, 54.7%).The proportion of patients age, cardiac insufficiency and cerebral infarction in frail group was higher than that in non-frail group(P<0.05), besides, the frailty group had larger numbers of comorbidities(≥4), of medications(>5) and of COPD level.There were 6 cases of AECOPD hospitalization in non-frail group within 3 months, compared with 45 cases in frailty group(P<0.05).Through binary logistic regression analysis, frailty was the greatest impact on rehospitalization of AECOPD(OR=35.247, 95%CI=10.57-117.527,P<0.05).Conclusion The fragile elderly people have higher risk of rehospitalization for AECOPD within three months.
Objective To analyze of the clinical data of inpatients with COPD from Respiratory Department of Geriatric Hospital, and hospitalization survey on AECOPD and frailty, and to study the relationship between frailty and rehospitalized for AECOPD in elderly patients.Methods A total of 117 inpatients with AECOPD from September 1,2015 to October 31,2018 were prospectively recruited in this study. Diagnosis of frailty was evaluated with CFS within 24 hours of discharge, and then they were assigned into the frailty group and non-frailty group. General clinical data, disease history, number of comorbidities and drug use were collected. All patients were followed up for 3 months for AECOPD re-hospitalization.Results According to CFS evaluation results, 117 patients were divided into two groups, frailty group(n=53, 45.3%) and non-frailty group(n=64, 54.7%).The proportion of patients age, cardiac insufficiency and cerebral infarction in frail group was higher than that in non-frail group(P<0.05), besides, the frailty group had larger numbers of comorbidities(≥4), of medications(>5) and of COPD level.There were 6 cases of AECOPD hospitalization in non-frail group within 3 months, compared with 45 cases in frailty group(P<0.05).Through binary logistic regression analysis, frailty was the greatest impact on rehospitalization of AECOPD(OR=35.247, 95%CI=10.57-117.527,P<0.05).Conclusion The fragile elderly people have higher risk of rehospitalization for AECOPD within three months.
引文
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[19] Mittal N,Raj R,Islam EA,et al.The frequency of frailty inambulatory patients with chronic lung diseases[J].Prim Care Community Health,2016,7:10-15.
[20] Morley JE,Vellas B,van Kan GA,et al.Frailty consensus:a call to action[J].J Am Med Dir Assoc,2013,14(6):392-397.
[21] 侯苹,刘永兵,孙凯旋,等.老年衰弱综合征干预措施及效果的研究进展[J].中国老年学杂志,2018,38(14):3578-3581.
[2] Lahousse L,Ziere G,Verlinden VJ,et al.Risk of frailty in elderly with COPD:a population-based study[J].Gerontol A Biol Sci Med Sci,2016,71(5):689-695.
[3] Vaz Fragoso CA,Enright PL,McAvay G,et al.Frailty and respiratory impairment in older persons[J].Am J Med,2012,125(1):79-86.
[4] Park SK,Richardson CR,Holleman RG,et al.Frailty in people with COPD,using the National Health and Nutrition Evaluation survey dataset(2003-2006)[J].Heart Lung,2013,42(3):163-170.
[5] Kon SS,Jones SE,Schofield SJ,et al.Gait speed and readmission following hospitalization for acute exacerbations of COPD:a prospective study[J].Thorax,2015,70(12):1131-1137.
[6] 康琳,朱鸣雷,刘晓红,等.衰弱与老年人冠状动脉粥样硬化性心脏病的相关性研究[J].中华老年医学杂志,2015,34(9):951-955.
[7] Fried LP,Tangen CM,Walston J,et al.Frailty inolder adults:evidence for a phenotype[J].J Gerontol A Biol Sci Med Sci,2001,56(3):M146-156.
[8] Ensrud KE,Ewing SK,Cawthon PM,et al.A comparison of frailty indexes for the prediction offalls,disability,fractures,and mortality in older men[J].J Am Geriatr Soc,2009,57(3):492-498.
[9] British Columbia.Frailty in older adults-early identification and management[EB/OL].http://guide.medlive cn/guideline/14518
[10] Rockwood K.A global clinical measure of fitness and frailty in elderly people[J].Can Med Assoc,2005,173(5):489-495.
[11] 乔静,王青,赵清华.老年住院患者用药情况与衰弱的关系分析[J].中华现代护理杂志,2016,22(18):2539-2541.
[12] 赵清华,王青,吴薇,等.老年住院患者衰弱指数与血压水平的关系[J].中华老年心脑血管病杂志,2016,18(4):1009-1026.
[13] 汤雯,姜春燕,孙颖,等.老年住院患者衰弱状态评估[J].临床和实验医学杂志,2019,18(2):187-192.
[14] Maddocks M,Kon SS,Canavan GJL,et al.Physical frailty and pulmonary rehabilitationin COPD:a prospective cohort study[J].Thorax,2016,71(11):988-995.
[15] Joosten E,Demuynck M,Detroyer E,et al.Prevalence of frailty and its ability to predict in hospital delirium,falls,and 6-month mortality in hospitalized older patients [J].BMC Geriatr,2014,14:1.
[16] 符琳琳,王青,吕卫华,等.老年住院患者衰弱与估算肾小球滤过率降低对再住院风险的影响[J].中华老年多器官疾病杂志,2018,17(5):334-338.
[17] 于普林,胡世莲.加强对老年人衰弱的识别和管理[J].中国临床保健杂志,2017,20(1):1-2.
[18] Milne KM,Kwan JM,Guler S,et al.Frailty is common and strongly associatedwith dyspnoea severity in fibrotic interstitial lung disease[J].Respirology,2017,22(4):728-734.
[19] Mittal N,Raj R,Islam EA,et al.The frequency of frailty inambulatory patients with chronic lung diseases[J].Prim Care Community Health,2016,7:10-15.
[20] Morley JE,Vellas B,van Kan GA,et al.Frailty consensus:a call to action[J].J Am Med Dir Assoc,2013,14(6):392-397.
[21] 侯苹,刘永兵,孙凯旋,等.老年衰弱综合征干预措施及效果的研究进展[J].中国老年学杂志,2018,38(14):3578-3581.