呼吸康复对慢性阻塞性肺疾病患者的疗效及影响预后的危险因素分析：回顾性研究

关键词：呼吸康复  慢性阻塞性肺疾病  疗效  预后  危险因素

Keywords:respiratory rehabilitation  chronic obstructive pulmonary disease  effect  prognosis  risk factors

摘要：

      摘要 目的：评估呼吸康复对慢性阻塞性肺疾病患者1年疗效的影响，以及确定影响预后的危险因素。 方法：回顾性分析于2017年1月至2019年3月因急性加重在广州医科大学附属第一医院住院的慢性阻塞性肺疾病患者，根据是否进行过呼吸康复治疗分为呼吸康复组和常规治疗组后，采用1∶1倾向性评分匹配纳入418例目标患者。其中，呼吸康复组209例和常规治疗组209例，比较两组出院后1年的疗效。根据是否发生预后不良事件（死亡或加重住院）分为预后良好组和预后不良组，以及根据生存时间＞1年和＜1年分为生存组和死亡组。采用χ2检验进行单因素分析，以及多因素Logistic回归模型和多因素Cox比例风险回归模型进行多因素分析。 结果：出院后1年，呼吸康复组比常规治疗组加重住院次数更少[（0.89±1.21）次和（1.23±1.18）次， P=0.008]，年加重住院率（43.5%和61.7%， P＜0.001）和年频繁加重住院率（16.7%和28.2%， P=0.006）更低，而两组年死亡率无显著性差异（15.3%和13.4%， P＞0.05）。预后不良组的进行呼吸康复治疗情况、既往1年加重住院情况、动脉血CO2分压水平和碳酸氢根水平与预后良好组有显著性差异（P＜0.05）。死亡组的动脉血CO2分压水平和静脉血血红蛋白水平与生存组有显著性差异（P＜0.05）。多因素Logistic二元回归分析显示既往1年有加重住院史、无呼吸康复治疗史、贫血和高碳酸血症是出院后1年预后不良的独立危险因素（P＜0.05）。多因素Cox比例风险回归分析显示贫血和高碳酸血症是出院后1年死亡的独立危险因素（P＜0.05）。 结论：住院早期延续至出院后的呼吸康复治疗可以有效降低慢性阻塞性肺疾病患者出院后1年死亡或再次加重住院的复合风险。贫血和高碳酸血症是出院后1年死亡的危险因素，既往有加重住院史是出院后1年死亡或再次加重住院的危险因素。

Abstract:

      Abstract Objective： To evaluate the one year therapeutic effect of respiratory rehabilitation in patients with chronic obstructive pulmonary disease （COPD） and identify prognostic risk factors. Method： COPD patients， hospitalized in the First Affiliated Hospital of Guangzhou Medical University from January 2017 to March 2019， were retrospectively analyzed. A total of 418 target patients， enrolled by 1∶1 propensity score matching， were divided into respiratory rehabilitation group and conventional treatment group according to whether they had received respiratory rehabilitation therapy. Among them， 209 cases in respiratory rehabilitation group and 209 cases in conventional treatment group were compared one year after discharge. According to the occurrence of adverse prognostic events （death or aggravated hospitalization）， the patients were divided into favorable prognosis group and bad prognosis group. According to the survival time > 1 year and < 1 year，the patients were divided into survival group and death group. χ2 test was used for univariate analysis， and multivariate logistic regression model and multivariate cox proportional hazards regression model were used for multivariate analysis. Result： One year after discharge， respiratory rehabilitation group had fewer exacerbation hospitalizations than conventional treatment group （0.89±1.21 vs. 1.23±1.18， P=0.008）， fewer annual exacerbation hospitalizations （43.5% vs. 61.7%， P<0.001） and fewer annual frequent exacerbation hospitalizations （16.7% vs. 28.2%， P=0.006）， but no significant difference in the annual mortality between two groups （15.3% vs 13.4%， P>0.05）. There were significant differences between the poor prognosis group and the favorable prognosis group in respiratory rehabilitation therapy， history of aggravated hospitalization in the previous year， arterial blood carbon dioxide level and bicarbonate level （P<0.05）. Arterial blood carbon dioxide level and venous blood hemoglobin level in the death group were significantly different from those in the survival group （P<0.05）. Multivariate logistic regression analysis showed that the history of exacerbation hospitalization， no respiratory rehabilitation in the previous year， anemia and hypercapnia were independent risk factors for poor prognosis one year after discharge （P<0.05）. Multivariate cox proportional hazards regression analysis showed that anemia and hypercapnia were independent risk factors for mortality one year after discharge （P<0.05）. Conclusion： Respiratory rehabilitation therapy extended from early hospitalization to discharge effectively reduced the composite risk of death or re-exacerbation of hospitalization in COPD patients one year after discharge， which is worthy of promotion. Anemia and hypercapnia were risk factors for death one year after discharge， and history of previous exacerbation hospitalization was a risk factor for death or re-exacerbation hospitalization after one year discharge.