| Objective:The purpose of this paper is to collect the data of diagnosis, treatment and follow-up of AECOPD patients, through the epidemiological analysis in AECOPD hospitalized patients, so as to induce the clinical diagnosis and treatment and the problems of health management, etc. Comparing the Global Initiative for Chronic Obstructive Lung Disease(GOLD), individualized diagnosis and treatment and health management improvement measurement are put forward, and to provide the basis for improving the prognosis of patients with AECOPD.Method:200 adults in The Second Hospital of Hebei Medical University were recruited using a cluster stratified random sampling method, from January 2013 to January 2014, and all of them, the primary diagnosis were AECOPD and had a complete medical records. Collecting the general clinical data and the CAT(COPD Assessment Test) score and the m MRC(modified British medical research council) score of the hospitalized patients with AECOPD on admission and at discharge, and the plateau pulmonary function of the patients, comparing the CAT score values change of the patients with AECOPD before and after treatment, checking the consistency of the assessment of the patient condition by CAT and m MRC score, collecting the distribution of microbial test results and the usage of antibacterial drugs, the ratio of ICU admission, the usage of the mechanical ventilation, the outcome, the application of glucocorticoids, the distribution of inhaled drug, and following up the usage, compliance, standardization, and again attack time interval of the discharged patients with AECOPD. Comprehensive analysis, finding the problem, presenting the improvement measures.Results:1 The general data: The average age of the hospitalized patients with AECOPD was(62.80±7.31)year, the gender ratio of male and female was 157/43, the average duration was(10.13±3.27) years, the ratio of smoker/ non-smoker was 143/57, the average of smoking history was(32.45±35.49) years, the average time of SAE of the year before was(2.21±1.43), the average hospitalization days was(14.07 ±7.09) days. the ratio of the people who got better when out of the hospital and automatic discharge was 144/47, while nine people died.2 The average CAT score of acute exacerbation period of COPD was(24.72±5.69) points, significantly higher than the plateau period of COPD(20.54±6.58) points. The difference was statistically significant(P=0.00 <0.05).3 Utilizing Kappa test to test of the consistency of evaluation by m MRC and CAT, the coefficient of Kappa test was 0.647, for a high degree of consistency.4 Microbiology results of sputum culture: the positive result was 91 cases(45.5%), and among them, bacteria accounted for 33% and fungi accounted for 30%. The infected bacteria were mostly G-bacilli. Especially acinetobacter baumanii(21%), klebsiella pneumoniae(19%), pseudomonas aeuginosa(17%) primarily. And streptococcus viridans(4%), e. coli(4%), sewer, e. coli(4%), excrement enterococcus(3%), corynebacterium(3%), eosinophilic malt narrow food(3%), s. pneumoniae bacterium(3%), gas Pasteur bacteria(1%), at the same time, alzheimer’s, e. coli(1%) was found as well. Part of the bacillus concrete that checked out was unknown(17%). The main fungus was candida albicans(75%) and tropical candida(8%), meanwhile, aspergillus(7%) and smooth candida(5%) were found as well. Part of the hyphae and spores that checked out was unknown.5 Specific medications: 200 patients with AECOPD were cured with antibiotics, the specific antibiotics distribution: specific to quinolones combined with β-Lactamase were 83 cases(32%), β-Lactamase alone were 50 cases(19%), quinolones combined with β-lactam antibiotics were 44 cases(17%) primarily, in addition, using β-lactam alone were 41 cases(16%), quinolones combined with carbapenems were 29 cases(11%), using carbapenems alone were 9 cases(3%), using quinolone alone were 5 cases(2%). Besides that, quinolone combined with carbapenems and amikacin were 3 cases, quinolone combined with carbapenems and tigecycline were 2 cases, quinolone combined with carbapenems and vancomycin were 2 cases, quinolone combined with β-lactam and amikacin was 1 case, quinolone combined with carbapenems and polymyxin E was 1 case, quinolone combined with β-lactam and vancomycin was 1 case, Moreover, antibacterial drug used combined with antifungal medicines, were 24 cases(12%) of all sample. Intravenous hormone use: 40% of patients intravenous application of methylprednisolone; among them, 47 cases(58.75%) used glucocorticoid in short-range therapy and sudden withdrawal, 33 cases(41.25%) of patients applied glucocorticoid by de-escalation therapy. The average daily dosage was(49.18±20.15)mg. Average application days was(3.12±3.08)days, the average of total dosage(of methylprednisolone) was(243.56±199.31)mg. The therapy prognosis had minor differences between practicing short-range and sudden withdrawal therapy and de-escalation therapy with glucocorticoid. They all had a better symptom improvement.6 Among 200 patients with AECOPD, there were 39(19.5%) cases patients treated in ICU, mechanical ventilation in 43(21.5%) cases, among them, 34(17.0%) patients with noninvasive ventilation, in witch, 27 cases of ICU admission, 9(4.5%) patients with invasive ventilation, and they were all of ICU admission.7 Telephone follow-up: There were 73 patients had not successfully followed among 191 hospitalized patients, there were 36 patients not aggravated by follow-up among 118 patients that successful follow-up, the average aggravation interval of the remaining 82 patients was(3.573±2.811) months, among of them, 34 patients were hospitalized, the medication usage of 118 patients with follow-up successful as follows: 24(20.3%) of 118 patients without inhaled medicines, among 94 patients with inhaled medicines, 39(41.5%) cases used symbicort turbuhaler or seretide or inhaled salbutamol sulfate not rinsed mouth as prescribed, 72 patients(76.6%) self-serving added the inhaled medicine when the chest symptoms worse. All of the 118 patients with follow-up successful application antibiotics and liquorice or other cough medicines unknown when the symptoms got worse(100%), in witch, 64(54.2%) patients received aminophyllinethe.Conclusion:For hospitalized patients with AECOPD, we shall do a CAT or m MRC score; in terms of antibiotics application, we should combine with chest imaging findings, especially lung CT, and sputum character, lung auscultation, history of prior treatment, sputum microbial test r-esults and medicine susceptibility results, thus estimating the condition respiratory infection comprehensive. Deciding whether to use antimicro-bial medicines or not, and selecting the type and level, consequently; advocating to choose short-range intravenous glucocorticoid; according to the patient’s specific conditions, in combination with GOLD guide, guiding the discharged patients complete the stabilization treatment to follow the doctor’s orders, adhere to the regular follow-up, and reduce the number of hospitalization. |
PDF Full Text Request