Spirometric criteria for hospital admission of patients with acute exacerbation of COPD.
Spirometric criteria for hospital admission of patients with acute exacerbation of COPD.
复制标题
COPD 急性加重患者入院的肺活量测定标准。
作者：
C. Emerman;D. Effron;T. Lukens
最近的研究表明，慢性阻塞性肺疾病(COPD)急性加重治疗后急诊科出院的患者复发率很高。还没有建立客观标准来确定这些患者何时住院。这项研究评估了该用途的肺活量测定标准。对83名COPD急性加重患者进行了研究；45%的患者入院，而出院的患者中有17%复发。不到40%的预测正常识别患者的FEV1需要住院或复发，敏感性为0.96，特异性为0.58，总体准确性为0.78。结合临床评估和肺活量测定，特异度提高到0.73，敏感度下降最小。治疗后FEV1达到或超过预计正常呼吸窘迫临床证据的40%或以上的患者可以安全出院。不符合这些标准的患者复发的风险很高，应该入院或进行进一步的积极ED治疗。
Recent studies have demonstrated that there is a high relapse rate for patients discharged from the Emergency Department (ED) following treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD). Objective criteria have not been established to determine when to hospitalize these patients. This study evaluated spirometric criteria for that use. Eighty-three patients with an acute exacerbation of COPD were studied; 45 percent were admitted to the hospital while 17 percent of the patients who were discharged suffered a relapse. An FEV1 of less than 40 percent of predicted normal identified patients who required hospital admission or suffered a relapse with a sensitivity of 0.96, specificity of 0.58, and overall accuracy of 0.78. Combining clinical assessment with spirometry led to an improvement in specificity to 0.73 with a minimal decrease in sensitivity. Patients with an FEV1 of 40 percent or greater of predicted normal or no clinical evidence of respiratory distress after treatment may be safely discharged from the hospital. Patients not meeting these criteria are at high risk for relapse and should either be admitted or have further aggressive ED therapy.