慢性阻塞性肺病急性发作住院患者的7点循证护理出院方案：共识策略和专家建议-动脉网

A 7-point evidence-based care discharge protocol for patients hospitalized for exacerbation of COPD: consensus strategy and expert recommendation

Nature 等信源发布 2024-12-20 18:06

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AbstractAcute exacerbations of COPD (ECOPD) are an important event in the life of a COPD patient as it causes significant deterioration of physical, mental, and social health, hastens disease progression, increases the risk of dying and causes a huge economic loss. Preventing ECOPD is therefore one of the most important goals in the management of COPD.

摘要COPD急性加重（ECOPD）是COPD患者生活中的重要事件，因为它会导致身体，心理和社会健康的显着恶化，加速疾病进展，增加死亡风险并导致巨大的经济损失。因此，预防ECOPD是COPD管理中最重要的目标之一。

Before the patient is discharged after hospitalization for ECOPD, it is crucial to offer an evidence-based care bundle protocol that will help minimize the future risk of readmissions and death. To develop the content of this quality care bundle, an Expert Working Group was formed, which performed a systematic review of literature, brainstormed, and debated on key clinical issues before arriving at a consensus strategy that could help physicians achieve this goal.

在患者因ECOPD住院后出院之前，至关重要的是提供一个基于证据的护理包协议，这将有助于最大程度地降低未来再入院和死亡的风险。为了制定这一优质护理包的内容，成立了一个专家工作组，该工作组对文献进行了系统回顾，进行了头脑风暴，并就关键的临床问题进行了辩论，然后达成了一项共识策略，可以帮助医生实现这一目标。

A 7-point consensus strategy was prepared, which included: (1) enhancing awareness and seriousness of ECOPD, (2) identifying patients at risk for future exacerbations, (3) optimizing pharmacologic treatment of COPD, (4) identifying and treating comorbidities, (5) preventing bacterial and viral infections, (6) pulmonary rehabilitation, and (7) palliative care.

制定了7点共识策略，其中包括：（1）提高ECOPD的意识和严重性，（2）确定未来恶化风险的患者，（3）优化COPD的药物治疗，（4）确定和治疗合并症，（5）预防细菌和病毒感染，（6）肺康复，以及（7）姑息治疗。

Physicians may find this 7-point care bundle useful to minimize the risk of future exacerbations and reduce morbidity and mortality..

医生可能会发现这种7点护理包有助于最大程度地降低未来恶化的风险，并降低发病率和死亡率。。

IntroductionChronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease, accounting for 3.2 million deaths every year1. Acute exacerbation of COPD (ECOPD), defined as “an event characterized by dyspnea and/or cough and sputum that worsens over less than 14 days”, is an important event in the course of COPD because it causes significant deterioration of physical, mental and social health, hastens disease progression, increases the risk of dying and causes a substantial economic loss not only to the patient and his/her family, but also to the society2.In-hospital mortality for ECOPD ranges from 2.5 to 25%3,4 and among those who survive, 25–55% get readmitted5.

引言慢性阻塞性肺病（COPD）是一种慢性进行性肺病，每年死亡320万人1。COPD急性加重（ECOPD）被定义为“以呼吸困难和/或咳嗽和痰液为特征的事件，在不到14天内恶化”，是COPD过程中的一个重要事件，因为它会导致身体，心理和社会健康的显着恶化，加速疾病进展，增加死亡风险，不仅给患者及其家人，而且给社会造成重大经济损失2.ECOPD的院内死亡率为2.5%至25%3,4，在存活的患者中，25%至55%被重新接纳5。

The 2-year and 5-year mortality rates after hospitalization for ECOPD are 26% and 58%, respectively6,7. Readmission rates for ECOPD are the highest among all chronic disease conditions8. In a systematic review of 57 studies from 30 different countries, readmission rates for COPD were reported to be 2.6–82% at 30 days, 11.8–45% at 31–90 days, 18–63% at 180 days, and 25–87% at 365 days9.Between 5.2 and 30% of patients with COPD have more than 2 exacerbations every year necessitating hospitalizations10.

ECOPD住院后2年和5年死亡率分别为26%和58%6,7。。在对来自30个不同国家的57项研究进行的系统评价中，据报道，COPD的再入院率在30天时为2.6-82%，在31-90天时为11.8-45%，在180天时为18-63%，在365天时为25-87%9。5.2%至30%的COPD患者每年有2次以上的恶化需要住院10。

Every episode of ECOPD affects the natural history of the disease, causing a steeper decline in lung function that does not return to its baseline value11 (Fig. 1). Exacerbations become more frequent as the severity of COPD increases, with more than 85% of the readmissions for ECOPD occurring in GOLD Stages III and IV12.Fig.

ECOPD的每一次发作都会影响疾病的自然史，导致肺功能急剧下降，并没有恢复到基线值11（图1）。随着COPD严重程度的增加，恶化变得更加频繁，超过85%的ECOPD再入院发生在GOLD III期和IV12期。

1: Decline in Lung Function with each subsequent COPD exacerbation.Accelerated rate of decline in lung function along with permanent loss of lung volume with each COPD exacerbation.Full size imageECOPD causes a huge economic loss13. In the UK, it accounts for 60% of the £1 bi.

1：随着随后的COPD恶化，肺功能下降。随着每次COPD恶化，肺功能下降速度加快，肺容量永久性减少。全尺寸ImageCOPD会造成巨大的经济损失13。在英国，它占100亿英镑的60%。

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Download referencesAcknowledgementsThis project was supported by Cipla Ltd, but did not participate in literature search, debates, discussions, manuscript writing and final manuscript evaluation.Author informationAuthors and AffiliationsPulmocare Research and Education Foundation, Pune, IndiaSundeep Salvi & Deesha GhorpadeSymbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, IndiaSundeep SalviDepartment of Pulmonary Medicine, Government Medical College, Thrissur, IndiaSanjeev NairDepartment Respiratory of Medicine, PD Hinduja Hospital, Mumbai, IndiaLancelot PintoDepartment of Pulmonary and Critical Care Medicine, Regency Hospital Kanpur, Kanpur, IndiaAshok K.

下载参考文献致谢该项目得到了Cipla Ltd的支持，但未参与文献检索，辩论，讨论，稿件撰写和最终稿件评估。作者信息作者和所属机构印度桑迪普·萨尔维和迪莎·戈尔帕德妇女共生医学院，印度桑迪普·萨尔维共生大学医院和研究中心，印度桑迪普·萨尔维德共生国际（视同大学），普纳，印度桑迪普·萨尔维德政府医学院肺部医学系，特里瑟尔，印度桑捷耶夫·奈尔德医学院，PD印度贾医院，孟买，印度兰塞洛特·平托肺部和重症监护医学系，坎普尔摄政医院，坎普尔，印度阿肖克。

SinghDepartment of Pulmonology Sooriya Hospital, Chennai, IndiaK. VenugopalDepartment of Respiratory Medicine, CK Birla Hospitals, Kolkata, IndiaRaja DharMetro Respiratory Center, Metro Hospitals and Heart Institute, Noida, IndiaDeepak TalwarSher-i-Kashmir Institute of Medical Sciences University, Ganderbal, IndiaParvaiz KoulDepartment of Respiratory Medicine, Lilavati Hospital and Research Centre, Mumbai, IndiaPralhad PrabhudesaiAuthorsSundeep SalviView author publicationsYou can also search for this author in.

印度钦奈Sooriya医院肺科SinghDepartment。维努戈帕尔呼吸医学系，CK Birla医院，加尔各答，IndiaRaja DharMetro呼吸中心，Metro Hospitals and Heart Institute，Noida，Indiadepak TalwarSher-i-Kshmir医学科学研究所，Ganderbal，IndiaParvaiz KoulDepartment of Respiratory Medicine，Lilavati Hospital and Research Centre，Mumbai，Indiaprahad Prabhudesai Authors Sundeep SalviView author Publications你也可以在中搜索这位作者。

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PubMed Google ScholarContributionsS.S. was a major contributor in writing the manuscript; D.G. contributed to the literature search and manuscript writing; S.N. contributed as a part of the expert panelist and contributed to the literature search; L.P. contributed as a part of the expert panelist and contributed to the literature search; A.S.

PubMed谷歌学术贡献。S、是撰写手稿的主要贡献者；D、 G.为文献检索和手稿撰写做出了贡献；S、 N.作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献；五十、 P.作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献；A、 S。

contributed as a part of the expert panelist and contributed to the literature search; K.V. contributed as a part of the expert panelist and contributed to the literature search; R.D. contributed as a part of the expert panelist and contributed to the literature search; D.T. contributed as a part of the expert panelist and contributed to the literature search; P.K.

作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献；K、 V.作为专家小组成员的一部分做出贡献，并为文献检索做出贡献；R、；D、 T.作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献；P、 K。

contributed as a part of the expert panelist and contributed to the literature search; P.P. contributed as a part of the expert panelist and contributed to the literature search. All authors read and approved the final manuscript.Corresponding authorCorrespondence to.

作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献；P、 P.作为专家小组成员的一部分做出了贡献，并为文献检索做出了贡献。所有作者都阅读并批准了最终手稿。对应作者对应。

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Reprints and permissionsAbout this articleCite this articleSalvi, S., Ghorpade, D., Nair, S. et al. A 7-point evidence-based care discharge protocol for patients hospitalized for exacerbation of COPD: consensus strategy and expert recommendation.

转载和许可本文引用本文Salvi，S.，Ghorpade，D.，Nair，S。等人。针对因COPD恶化住院的患者的7点循证护理出院方案：共识策略和专家建议。

npj Prim. Care Respir. Med. 34, 44 (2024). https://doi.org/10.1038/s41533-024-00378-7Download citationReceived: 03 November 2023Accepted: 21 June 2024Published: 20 December 2024DOI: https://doi.org/10.1038/s41533-024-00378-7Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

npj首席。护理呼吸。医学杂志34，44（2024）。https://doi.org/10.1038/s41533-024-00378-7Download引文接收日期：2023年11月3日接收日期：2024年6月21日发布日期：2024年12月20日OI：https://doi.org/10.1038/s41533-024-00378-7Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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