帕金森病住院期间恶化：684 例患者调查。
Deterioration of Parkinson's disease during hospitalization: survey of 684 patients.
机构信息
Section of Movement Disorders, Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
出版信息
BMC Neurol. 2012 Mar 8;12:13. doi: 10.1186/1471-2377-12-13.
BACKGROUND
A substantial fraction of Parkinson's disease patients deteriorate during hospitalisation, but the precise proportion and the reasons why have not been studied systematically and the focus has been on surgical wards and on Accident & Emergency departments. We assessed the prevalence and risk factors of deterioration of Parkinson's disease symptoms during hospitalization, including all wards.
METHODS
We invited Parkinson's disease patients from three neurology departments in The Netherlands to answer a standardised questionnaire on general, disease and hospital related issues. Patients who had been hospitalized in the previous year were included and analysed. Possible risk factors for Parkinson's disease deterioration were identified. Proportions were analysed using the Chi-Square test and a logistic regression analysis was performed.
RESULTS
Eighteen percent of 684 Parkinson's disease patients had been hospitalized at least once in the last year. Twenty-one percent experienced deterioration of motor symptoms, 33% did have one or more complications and 26% had received incorrect anti-Parkinson's medication. There were no statistically significant differences for these variables between admissions on neurologic or non-neurologic wards and between having surgery or not. Incorrect medication during hospitalization was significantly associated with higher risk (OR 5.8, CI 2.5-13.7) of deterioration, as were having infections (OR 6.7 CI 1.8-24.7). A higher levodopa equivalent dose per day was a significant risk factor for deterioration. When adjusting for different variables, wrong medication distribution was the most important risk factor for deterioration.
CONCLUSIONS
Incorrect medication and infections are the important risk factors for deterioration of Parkinson's disease patients both for admissions with and without surgery and both for admissions on neurologic and non-neurologic wards. Measures should be taken to improve care and incorporated in guidelines.
背景
相当一部分帕金森病患者在住院期间病情恶化，但具体比例和原因尚未得到系统研究，研究重点主要集中在外科病房和急症部门。我们评估了包括所有病房在内的帕金森病患者住院期间症状恶化的患病率和危险因素。
方法
我们邀请了荷兰三个神经病学部门的帕金森病患者回答一个关于一般、疾病和医院相关问题的标准化问卷。纳入并分析了过去一年住院的患者。确定了帕金森病恶化的可能危险因素。使用卡方检验分析比例，并进行逻辑回归分析。
结果
684 名帕金森病患者中，18%的患者在过去一年中至少住院一次。21%的患者出现运动症状恶化，33%的患者出现一种或多种并发症，26%的患者接受了错误的抗帕金森病药物治疗。在神经科和非神经科病房之间、是否接受手术之间，这些变量没有统计学上的显著差异。住院期间使用错误的药物与更高的恶化风险显著相关（OR 5.8，95%CI 2.5-13.7），感染也是如此（OR 6.7，95%CI 1.8-24.7）。每天左旋多巴等效剂量较高是恶化的一个显著危险因素。在调整不同变量后，错误的药物分配是恶化的最重要危险因素。
结论
错误的药物和感染是帕金森病患者恶化的重要危险因素，无论是接受手术还是非手术的患者，无论是在神经科还是非神经科病房的患者。应采取措施改善护理，并纳入指南。
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