慢性阻塞性肺疾病急性加重期患者短期预后预测模型的建立
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摘要
目的建立适合于急诊科医护人员使用的评估COPD急性加重期患者病情危重程度的预测规则,以便更好地辨识危重患者并及时为其提供治疗、护理干预。方法采用方便取样的方法,收集2017年3月—2018年1月进入急诊科的符合纳入、排除标准的COPD急性加重期患者信息,将患者分为病情平稳组和病情危重组,对两组患者资料进行单因素分析、Logistic回归分析,从而得出模型并对其进行简化。结果本研究共纳入142例患者,国家早期预警评分、Charlson合并症指数、年龄这3个因素进入模型。模型对患者短期预后预测的ROC曲线下面积为0.903[95%CI(0.845,0.960)],进一步简化评分规则,其ROC曲线下面积为0.900。结论本研究所得预测模型可以科学、有效地对COPD急性加重期患者的预后进行预测,且所有指标简单易得,可快速获取,为急诊临床护理工作带来了便利。
Objective To establish a predictive model suitable for emergency medical staff to evaluate the severity of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),so as to better identify critical patients and provide timely treatment and nursing intervention. Methods The patients with AECOPD who visited the emergency department from March 2017 to January 2018 were enrolled using convenience sampling method and divided into stable group and critical group. The data of the two groups were analyzed by univariate analysis and logistic regression analysis to establish the model and simplify it. Results A total of 142 patients were included in the study. Three factors including NEWS,CCI and age,entered the model. The AUC predicted by the model was 0.903[95%CI(0.845,0.960)]. With further simplifying the scoring rules,then AUC was 0.900. Conclusion The predictive model in this study can better predict the prognosis of patients with AECOPD,and all the indicators are simple and easy to obtain,which is convenient for emergency clinical nursing to use.
Objective To establish a predictive model suitable for emergency medical staff to evaluate the severity of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),so as to better identify critical patients and provide timely treatment and nursing intervention. Methods The patients with AECOPD who visited the emergency department from March 2017 to January 2018 were enrolled using convenience sampling method and divided into stable group and critical group. The data of the two groups were analyzed by univariate analysis and logistic regression analysis to establish the model and simplify it. Results A total of 142 patients were included in the study. Three factors including NEWS,CCI and age,entered the model. The AUC predicted by the model was 0.903[95%CI(0.845,0.960)]. With further simplifying the scoring rules,then AUC was 0.900. Conclusion The predictive model in this study can better predict the prognosis of patients with AECOPD,and all the indicators are simple and easy to obtain,which is convenient for emergency clinical nursing to use.
引文
[1]王蕾,杨汀,王辰.2017年版慢性阻塞性肺疾病诊断、处理和预防全球策略解读[J].中国临床医生杂志,2017,45(1):104-108.
[2]钱传云,李涛.AECOPD急诊抗菌治疗略谈[J].中国急救医学,2013,33(10):865-868.
[3]Roca B,Almagro P,López F,et al.Factors associated with mortality in patients with exacerbation of chronic obstructive pulmonary disease hospitalized in general medicine departments[J].Intern Emerg Med,2011,6(1):47-54.
[4]李晓俊,王明航,李素云.慢性阻塞性肺疾病急性加重风险预警因子研究进展[J].中国全科医学,2016,19(35):4408-4412.
[5]Asiimwe AC,Brims FJ,Andrews NP,et al.Routine laboratory tests can predict in-hospital mortality in acute exacerbations of COPD[J].Lung,2011,189(3):225-232.
[6]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[7]Royal College of Physicians of London.National Early Warning Score(NEWS):standardizing the assessment of acute-illness severity in the NHS[EB/OL].[2018-04-01].https://www.rcplondon.ac.uk/resources/national-early-warning-score-news.
[8]Charlson M,Pompei P,Ales K,et al.A new method of classifying prognostic comorbidity in longitudinal studies:development and validation[J].J Chro Dis,1987,40:373-383.
[9]王长远,曹涛,汤辉,等.NEWS评分、MEWS评分和APACHEⅡ评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[10]黄文婷,崔妙玲,蒋云,等.慢性阻塞性肺疾病急性加重期患者病情评分工具的比较研究[J].中华护理杂志,2017,52(3):381-384.
[11]崔云亮,张树柳,田昭涛,等.两种基础疾病评分预测肺炎患者预后的比较[J].中华急诊医学杂志,2016,25(10):1278-1283.
[12]张霖,皮春梅,聂秀红.查尔森合并症指数对老年慢性阻塞性肺疾病患者预后的评估价值[J].中国呼吸与危重监护杂志,2016,15(4):333-336.
[13]中华医学会老年医学分会.老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志,2017,36(3):251-256.
[14]高晶晶,程意,罗勇.COPD常见共患病及其流行病学特点和临床意义[J].国际呼吸杂志,2017,37(1):70-75.
[15]施继红,蒲爱华.慢性阻塞性肺疾病急性加重期患者近期预后的影响因素分析[J].中国慢性病预防与控制,2017,25(11):853-855.
[2]钱传云,李涛.AECOPD急诊抗菌治疗略谈[J].中国急救医学,2013,33(10):865-868.
[3]Roca B,Almagro P,López F,et al.Factors associated with mortality in patients with exacerbation of chronic obstructive pulmonary disease hospitalized in general medicine departments[J].Intern Emerg Med,2011,6(1):47-54.
[4]李晓俊,王明航,李素云.慢性阻塞性肺疾病急性加重风险预警因子研究进展[J].中国全科医学,2016,19(35):4408-4412.
[5]Asiimwe AC,Brims FJ,Andrews NP,et al.Routine laboratory tests can predict in-hospital mortality in acute exacerbations of COPD[J].Lung,2011,189(3):225-232.
[6]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[7]Royal College of Physicians of London.National Early Warning Score(NEWS):standardizing the assessment of acute-illness severity in the NHS[EB/OL].[2018-04-01].https://www.rcplondon.ac.uk/resources/national-early-warning-score-news.
[8]Charlson M,Pompei P,Ales K,et al.A new method of classifying prognostic comorbidity in longitudinal studies:development and validation[J].J Chro Dis,1987,40:373-383.
[9]王长远,曹涛,汤辉,等.NEWS评分、MEWS评分和APACHEⅡ评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[10]黄文婷,崔妙玲,蒋云,等.慢性阻塞性肺疾病急性加重期患者病情评分工具的比较研究[J].中华护理杂志,2017,52(3):381-384.
[11]崔云亮,张树柳,田昭涛,等.两种基础疾病评分预测肺炎患者预后的比较[J].中华急诊医学杂志,2016,25(10):1278-1283.
[12]张霖,皮春梅,聂秀红.查尔森合并症指数对老年慢性阻塞性肺疾病患者预后的评估价值[J].中国呼吸与危重监护杂志,2016,15(4):333-336.
[13]中华医学会老年医学分会.老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志,2017,36(3):251-256.
[14]高晶晶,程意,罗勇.COPD常见共患病及其流行病学特点和临床意义[J].国际呼吸杂志,2017,37(1):70-75.
[15]施继红,蒲爱华.慢性阻塞性肺疾病急性加重期患者近期预后的影响因素分析[J].中国慢性病预防与控制,2017,25(11):853-855.