發(fā)布時間：2018-03-02 01:27

  本文關鍵詞： 慢性阻塞性肺疾病急性加重 危險因素 CURB-65評分 BAP-65評分 DECAF評分　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:分析慢性阻塞性肺疾病急性加重患者死亡相關的危險因素及探討CURB-65評分、BAP-65評分、DECAF評分對慢性阻塞性肺疾病急性加重住院患者預后的應用價值。方法:收集2014年1月至2016年1月天津醫(yī)科大學第二醫(yī)院呼吸科診斷為慢性阻塞性肺疾病急性加重的住院患者302例。收集在入院24小時臨床資料及實驗室數(shù)據,根據存活情況分為生存組與死亡組,分別比較生存組與死亡組臨床資料,分析死亡相關危險因素并進行CURB-65評分、BAP-65評分及DECAF評分,分別計算患者三種評分不同時患者的死亡率,構建ROC曲線分析CURB-65評分、BAP-65評分、DECAF評分對AECOPD患者院內死亡率的預測價值。結果:1、單因素分析結果示AECOPD患者死亡組在合并肺實變、合并房顫、嚴重呼吸困難、意識障礙所占比例均多于生存組,死亡組患者的血嗜酸性粒細胞數(shù)值、動脈血PH值、白蛋白、FEV1%占預計值的平均值較生存組低,血中性粒細胞百分百比、C-反應蛋白的平均值較生存組高,上述差異均有統(tǒng)計學意義(P0.05)。死亡組與生存組在年齡、白細胞數(shù)值、血紅蛋白、纖維蛋白原、D-二聚體、動脈血氧分壓、二氧化碳分壓、肌酐、血尿素氮、吸煙史無統(tǒng)計學差異(P0.05)。2、多因素分析結果顯示患者出現(xiàn)嚴重呼吸困難、意識障礙,合并肺實變、房顫,白蛋白低、嗜酸性粒細胞減少、PH值減低、CRP增高為患者院內死亡的獨立危險因素。3死亡組CURB-65評分、BAP-65評分、DECAF評分分值均高于生存組,差異具有統(tǒng)計學意義(P㩳0.05)。4、隨著三種評分分值的增加,患者院內死亡率的相應增加,DECAF評分及CURB-65評分在4分以上,院內死亡率分別為48%及50%。BAP-65評分在4分以上院內死亡率為80%。5、在預測院內死亡率上CURB-65評分和BAP-65評分曲線下面積在0.80以上,DECAF評分曲線下面積為約為0.95。三個評分的AUROC面積分別兩兩Z檢驗,結果示CURB-65評分與BAP-65評分比較,差異無統(tǒng)計學意義(P0.05),DECAF評分分別與CURB-65評分與BAP-65評分比較,差異有統(tǒng)計學意義(P0.05)。結論:1、AECOPD死亡相關危險因素有嚴重的呼吸困難、意識障礙、C反應蛋白水平增高、嗜酸性粒細胞數(shù)減低、酸中毒及合并肺實變、房顫,綜合參考上述指標評價患者預后。2、入院時進行CURB-65評分、BAP-65評分及DECAF評分,這三種評分對于預測慢性阻塞性肺疾病急性加重院內死亡率均有一定價值,DECAF評分在三個評分中對AECOPD患者預后預測準確度最高,值得臨床推廣使用。
[Abstract]:Objective: to analyze the risk factors related to death in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to explore the value of CURB-65 score BAP-65 and DECAF in the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). From January 2014 to January 2016, 302 inpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were diagnosed by the Department of Respiratory Medicine, second Hospital of Tianjin Medical University. Clinical data and laboratory data were collected after 24 hours of admission. According to the survival condition, the patients were divided into survival group and death group. The clinical data of survival group and death group were compared, the risk factors of death were analyzed, and the CURB-65 score, BAP-65 score and DECAF score were used to calculate the mortality of patients with different scores. ROC curve was constructed to analyze the prognostic value of CURB-65 score BAP-65 score and DECAF score in hospital mortality of AECOPD patients. Results: 1. Univariate analysis showed that the death group of AECOPD patients was complicated with pulmonary consolidation, atrial fibrillation and severe dyspnea. The mean values of eosinophils, PH in arterial blood, FEV1% of albumin in survival group were lower than those in survival group. The average percentage of neutrophils was higher than that of the survival group (P 0.05). Age, white blood cell value, hemoglobin, fibrinogen D-dimer, arterial oxygen partial pressure were measured in the dead group and the survival group. There was no significant difference in carbon dioxide partial pressure, creatinine, blood urea nitrogen, smoking history (P 0.05). Multivariate analysis showed that patients had severe dyspnea, disturbance of consciousness, complicated with pulmonary consolidation, atrial fibrillation, and low albumin. Decrease of PH value of eosinophilic granulocytes and elevation of CRP in patients with nosocomial death. 3 the CURB-65 score of death group and BAP-65 score and DECAF score were higher than those of survival group, and the difference was statistically significant (P < 0.05). With the increase of three kinds of scores, the mortality in hospital increased correspondingly. The scores of DECAF and CURB-65 were above 4. Hospital mortality was 48% and 50.BAP-65 scores were above 4. Hospital mortality rate was 80. 5. In predicting hospital mortality, the area under CURB-65 score and BAP-65 score curve was 0. 80 or above. The area under the score curve was about 0. 95. The area under the AUROC score was about 0. 95. A pair of Z test, The results showed that there was no significant difference between the CURB-65 score and the BAP-65 score. There was no significant difference between the CURB-65 score and the CURB-65 score and the BAP-65 score. The level of C-reactive protein increased, the number of eosinophils decreased, acidosis and complicated pulmonary consolidation, atrial fibrillation. The prognosis of patients was evaluated by referring to the above indexes. The CURB-65 score and BAP-65 and DECAF score were evaluated on admission. These three kinds of scores have certain value in predicting the hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DECAF score has the highest accuracy in predicting the prognosis of patients with AECOPD among the three scores, and it is worth popularizing in clinic.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.9

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