Duenk Ria G, Verhagen Stans C, Janssen Mireille Ae, Dekhuijzen Richard Pnr, Vissers Kris Cp, Engels Yvonne, Heijdra Yvonne
1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
2 Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Chron Respir Dis. 2017 Feb;14(1):63-71. doi: 10.1177/1479972316661922. Epub 2016 Nov 21.
To identify patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD) who have a poor prognosis and might benefit from proactive palliative care, a set of indicators had been developed from the literature. A patient is considered eligible for proactive palliative care when meeting ≥2 criteria of the proposed set of 11 indicators. In order to develop a doctor-friendly and patient-convenient tool, our primary objective was to examine whether these indicators are documented consistently in the medical records. Besides, percentage of patients with a poor prognosis and prognostic value were explored. We conducted a retrospective medical record review of 33 patients. Five indicators; non-invasive ventilation (NIV), comorbidity, body mass index (BMI), previous admissions for acute exacerbation COPD and age were always documented. Three indicators; hypoxaemia and/or hypercapnia, professional home care and actual forced expiratory volume1% (FEV1%) were documented in more than half of the records, whereas the clinical COPD questionnaire (CCQ), medical research council dyspnoea (MRC dyspnoea) and the surprise question were never registered. Besides, 78.8% of the patients met ≥2 criteria and there was a significant association between meeting ≥2 criteria and mortality within 1 year (one-sided Fisher's exact test, p = 0.04). The set of indicators for proactive palliative care in patients with COPD appeared to be user-friendly and feasible.
为了识别因慢性阻塞性肺疾病（COPD）急性加重而住院且预后较差、可能从积极的姑息治疗中获益的患者，已从文献中制定了一套指标。当患者符合所提出的11项指标中的≥2项标准时，即被认为符合积极姑息治疗的条件。为了开发一种对医生友好且对患者方便的工具，我们的主要目标是检查这些指标在病历中是否得到一致记录。此外，还探讨了预后较差患者的比例和预后价值。我们对33例患者的病历进行了回顾性审查。五项指标，即无创通气（NIV）、合并症、体重指数（BMI）、既往因COPD急性加重住院情况和年龄总是有记录。三项指标，即低氧血症和/或高碳酸血症、专业家庭护理和实际第1秒用力呼气量（FEV1%）在一半以上的记录中有记载，而临床COPD问卷（CCQ）、医学研究委员会呼吸困难量表（MRC呼吸困难量表）和意外问题从未被记录。此外，78.8%的患者符合≥2项标准，且符合≥2项标准与1年内死亡率之间存在显著关联（单侧Fisher精确检验，p = 0.04）。COPD患者积极姑息治疗的指标集似乎对用户友好且可行。
