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探讨急诊科就诊的慢性阻塞性肺疾病患者呼气末二氧化碳分压中测量的阿尔法角与 30 天内再入院之间的关系。

Investigation of the Relationship Between the Measured Alpha Angle in Capnography and Readmission Within Thirty Days in Chronic Obstructive Pulmonary Disease Patients Who Presented to the Emergency Department.

机构信息

Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.

Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.

出版信息

J Emerg Med. 2024 Nov;67(5):e393-e401. doi: 10.1016/j.jemermed.2024.05.013. Epub 2024 Jun 4.

Abstract

BACKGROUND

Individuals with chronic obstructive pulmonary disease (COPD) constitute a significant portion of patients who present to the emergency department with dyspnea. However, there is no ideal method for predicting mortality or making hospitalization decisions in the emergency department (ED). In this regard, objective findings are needed for these patients. Since there are no objective findings regarding the hospitalization decision, there may be an increase in the re-admission rate of patients who needed hospitalization but were decided to be discharged. Side-stream end-tidal carbon dioxide (EtCO) measurements offer a non-invasive, easy-to-interpret, quickly accessible, and reproducible method that can be applied at the bedside.

OBJECTIVES

The aim of this study was to evaluate the relationship between the alpha angle values obtained by capnography and readmission rates within 30 days for patients experiencing COPD exacerbations who presented to the ED with dyspnea and were discharged after treatment.

METHODS

In this study, we studied with 130 participants presented to the emergency department of a tertiary care university hospital with dyspnea, who are >18 y. Forty patients were excluded after evaluation for eligibility for the study. Thus, the data of 90 patients included were analyzed. We obtained alpha angle and EtCO values for all patients at the time of admission and also after treatment. The primary outcome measure of the study was the relationship between the patients' readmission situations within 30 days of the alpha angle measurements. The secondary outcome measure was the association between patients' EtCO values ​​and readmission within 30 days.

RESULTS

It was observed that both the pretreatment alpha angle values and the posttreatment alpha angle variables were statistically significant in predicting the readmission of the patients within 30 days (p = 0.001, p = 0.003) CONCLUSION: The results of this study show that alpha angle values measured for patients with COPD who present to the ED with the complaint of dyspnea may be used to predict readmission.

摘要

背景

慢性阻塞性肺疾病(COPD)患者在出现呼吸困难时会大量前往急诊科就诊,而这些患者构成了急诊科就诊患者的重要组成部分。然而,目前尚无理想的方法可以预测这些患者的死亡率或决定是否需要住院。在这方面,这些患者需要客观的检查结果。由于在决定患者是否需要住院时缺乏客观的检查结果,可能会增加那些需要住院但被决定出院的患者的再入院率。旁流呼气末二氧化碳(EtCO)测量提供了一种非侵入性、易于解释、快速获得且可重复的床边检测方法。

目的

本研究旨在评估 COPD 急性加重患者因呼吸困难就诊于急诊科并经治疗后出院,其呼气末二氧化碳(EtCO)测量中的α角值与 30 天内再入院率之间的关系。

方法

本研究共纳入 130 名因呼吸困难就诊于三级护理大学附属医院急诊科的患者,年龄均>18 岁。经评估后,有 40 名患者被排除出研究。因此,分析了 90 名患者的数据。我们在入院时以及治疗后为所有患者获取了α角和 EtCO 值。本研究的主要观察指标为α角测量值与患者 30 天内再入院情况之间的关系。次要观察指标为患者的 EtCO 值与 30 天内再入院之间的相关性。

结果

研究发现,治疗前和治疗后的α角值在预测患者 30 天内再入院方面均具有统计学意义(p=0.001,p=0.003)。

结论

本研究结果表明,在急诊科因呼吸困难就诊的 COPD 患者的α角值可用于预测再入院。

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