慢性阻塞性肺疾病急性加重期的管理变化。
Variations in the management of acute exacerbations of chronic obstructive pulmonary disease.
机构信息
Department of Medicine and Emergency Medicine, University of British Columbia, Vancouver, British Columbia V5Z 1M9.
出版信息
Can Respir J. 2013 May-Jun;20(3):175-9. doi: 10.1155/2013/501038.
BACKGROUND
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a significant cause of morbidity and mortality for patients with COPD. AECOPD are the leading cause of hospital admissions in Canada. Although multiple guidelines have been developed for the acute and chronic management of COPD, there are few quality assurance studies investigating adherence to these guidelines.
METHODS
A retrospective chart review of all patients admitted to a tertiary care hospital in 2009 for an AECOPD was performed. Using a standardized data abstraction tool, adherence to current guidelines across different physician groups and patient outcomes were assessed. Particular focus was centred on differences in management across physician groups.
RESULTS
Overall, 293 patients were evaluated. Of these, 82.6% were treated with one or more chronic COPD medication(s) in the community, with only 17.7% of patients treated with a long-acting inhaled anticholinergic medication. For treatment of AECOPD, 58% of patients received corticosteroids and 84% received antibiotics. Compared with general medicine and the hospitalist service, the respiratory medicine service demonstrated significantly better adherence with current treatment guidelines; however, even this was less than optimal. In addition, there was poor follow-up of patients cared for outside of the respiratory service.
CONCLUSIONS
The present study identified significant care gaps in the treatment of patients admitted with AECOPD and on their discharge.
背景
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）是 COPD 患者发病率和死亡率的重要原因。AECOPD 是加拿大住院的主要原因。尽管已经制定了多项 COPD 急性和慢性管理指南，但很少有质量保证研究调查这些指南的遵守情况。
方法
对 2009 年在一家三级护理医院因 AECOPD 住院的所有患者进行了回顾性图表审查。使用标准化数据提取工具，评估了不同医生群体和患者结局的依从性。特别关注医生群体之间管理上的差异。
结果
总体而言，评估了 293 名患者。其中，82.6%的患者在社区中接受了一种或多种慢性 COPD 药物治疗，只有 17.7%的患者接受了长效吸入抗胆碱能药物治疗。对于 AECOPD 的治疗，58%的患者接受了皮质类固醇治疗，84%的患者接受了抗生素治疗。与普通内科和医院服务相比，呼吸科服务明显更符合当前治疗指南，但即使如此也并不理想。此外，在呼吸科以外接受治疗的患者随访情况不佳。
结论
本研究确定了治疗因 AECOPD 入院和出院的患者存在明显的护理差距。
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