某醫學中心慢性阻塞性肺病病人急性發作之相關因素探討

Abstract

背景：近年來，慢性阻塞性肺病(Chronic Obstructive Pulmonary Disease，以下簡稱COPD)的盛行率及死亡率日益提高，健保署亦於2017年新增「慢性阻塞性肺病醫療給付改善方案」，希望藉此提高照護品質、減少病患急性發作次數。 目的：本研究期望瞭解持續於實習醫院接受照護之COPD病患，其急性發作相關的個人特質及風險因素，以作為後續照護及管理上的參考。 方法：本研究為次級資料庫分析，以回溯性世代方式進行。並以卡方檢定、T檢定、ANOVA及存活分析探討收案對象個人特質、疾病嚴重度、共病症與其急性發作機率、次數及風險之相關性。 結果：研究對象共293位COPD病人，其中101人(34.5%)在追蹤期間有急性發作至少1次。疾病嚴重度越高、BMI越低，其輕、中、重度急性發作機率及次數均較高，且急性發作風險亦較高；有糖尿病或高血壓共病症者，其急性發作機率及次數雖較高，但未達顯著相關。而年齡則與急性發作風險成正比，結果顯示年齡每增加一歲，急性發作風險比增加0.023倍 (95%CI, 1.00-1.04)；BMI則與急性發作風險成反比，BMI每增加1單位，急性發作風險比減少0.059倍 (95%CI, 0.90-0.99)；而BMI過重族群(24≦BMI<27)其急性發作風險為過輕者之0.365倍 (95%CI, 0.16-0.84)。在疾病嚴重度因素中，相對於最輕微的mild，其急性發作風險亦隨嚴重度提高而提升：中度提高1.192倍(95%CI, 0.725-1.958)，重度提高2.671倍 (95%CI, 1.528-4.671)，極重度提高4.101倍 (95%CI, 1.582-10.634)。 結論：透過本篇研究了解院內COPD病患急性發作之相關因素，建議本次實習之醫院未來可參考本研究之發現，結合相關資源，以提供病患完整且高品質的照護，降低COPD急性發作的風險。

Background: The prevalence and mortality rates of Chronic Obstructive Pulmonary Disease (COPD) have been increasing in recent years. In order to prevent frequent acute exacerbation (AE) and enhance the quality of health care, the National Health Insurance Administration has implemented “Chronic Obstructive Pulmonary Disease Pay-for performance Program” in 2017. Purpose: The purpose of this study is to explore the related factors of acute exacerbation in the practicum hospital to provide information for caring and management of COPD patients. Method: This study is a secondary data analysis study using a retrospective cohort from the practicum hospital. We used Chi-Squared test, Student’s t-test, ANOVA test, Kaplan-Meier Survival Curve and Cox Proportional Hazard Regression to analyze the correlation between personal characteristics, severity of COPD, comorbidities and probability of having AEs, number of AEs, and related risk factors. Results: A total of 293 COPD patients were included in the study and 101(34.5%) of them had at least one acute exacerbation during research period. The results indicate that probability, number and risk of having acute exacerbation became more frequent and higher as the severity of COPD increased and BMI decreased. Patients with diabetes and hypertension also have higher probability and more frequent acute exacerbation than patients without those two comorbidities. The risk of acute exacerbation increased 1.023 times (95%CI, 1.00-1.04) as age increase by 1 year, and increase 0.941 times (95%CI, 0.90-0.99) as BMI increased by 1 unit. Compared to mild, the probability of having AEs also increases: moderate by 1.192 times (95%CI, 0.725-1.958); severe by 2.671 times (95%CI, 1.528-4.671); and very severe increase by 4.101 times (95%CI, 1.582-10.634). Conclusion: Through the results of this research we can understand that the factors associate with acute exacerbation of COPD patients in the practicum hospital. In order to reduce the probability of having AEs, it is recommended that the practicum hospital can integrate related resources to provide more comprehensive and higher quality care in the future.