需要重症监护的住院哮喘患者：从社会历史的“红旗”角度
2016/08/22
摘要
背景和目的：澳大利亚的哮喘死亡与非法药物滥用、精神健康问题和社会问题有关。然而，这些死亡很大一部分发生在医院外，到患者寻求医疗帮助的时候已经很难逆转。我们假设，当他们前往急诊时，这些因素也可能会增加一个患者需要重症监护入院的风险。
方法：从2010年1月到2014年1月，我们研究了所有到一个三级城市医院住院的主要诊断为哮喘的患者。从审查图来获得临床和人口学数据。患者的邮编作为社会经济地位的象征。
结果：在研究期间，有482名哮喘患者住院，其中39个需要重症监护。与29例（7%）住在普通病房的患者相比，10例住进重症监护的患者（26%）使用了非法药物（调整后的比值比：3.6，P = 0.012）。对非法药物使用者而言，预防性治疗依从性差与重症监护病房住院的风险更高相关。需要重症监护的小组，其社会经济指数较低。在这两个群体中精神科诊断的频率是相似的。
结论：在入院治疗的哮喘患者中，非法药物滥用是重症监护需求的一个强大的独立危险因素。预防性治疗依从性差进一步增加了这种风险。较低的社会经济地位也与风险增加相关。这些历史的特点，应积极研究，可能作为有用的“危险信号”来及时考虑重症监护。
（苏欣 审校）
Respirology. 2016 Jun 19. doi: 10.1111/resp.12831. [Epub ahead of print]
Need for intensive care in patients admitted for asthma: Red flags from the social history.
Moghaddas F1, Smith C2, Pilcher D3, O'Hehir R1, Hew M1,4, Dabscheck E1,4.
Author information
Abstract
BACKGROUND AND OBJECTIVE:Asthma deaths in Australia are associated with illicit substance abuse, mental health problems and social issues. However, a large proportion of these deaths occurs out of hospital and is difficult to avert by the time the individuals seek medical attention. We hypothesized that these characteristics may also increase the risk for a patient to require intensive care admission when they present to emergency departments.
METHODS:We studied consecutive patients admitted to a tertiary metropolitan hospital with a primary diagnosis of asthma between January 2010 and January 2014. Clinical and demographical data were obtained from chart review. The patient's postcode was used as a surrogate for socioeconomic status.
RESULTS:There were 482 asthma patients admitted during the study period, of which 39 required intensive care. Ten patients admitted to intensive care (26%) used illicit drugs compared with 29 (7%) of those admitted to the ward (adjusted odds ratio: 3.6, P = 0.012). For illicit users, nonadherence to preventer therapy was associated with an even higher risk of intensive care unit admission. Socioeconomic index was lower in the group requiring intensive care admission. The frequency of psychiatric diagnoses was similar in both groups.
CONCLUSION:Among patients admitted to hospital for asthma, illicit substance abuse is a strong independent risk factor for intensive care requirement. Preventer therapy nonadherence further increases this risk. Lower socioeconomic status is also associated with increased risk. These historical features should be actively sought on admission and may serve as useful 'red flags' to prompt consideration of intensive monitoring.
© 2016 Asian Pacific Society of Respirology.
KEYWORDS:asthma; drug use; exacerbation; intensive care unit; psychiatric illness
Respirology. 2016 Jun 19. doi: 10.1111/resp.12831. [Epub ahead of print]
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成人早发性和迟发性哮喘的临床和功能差异：基于人群的塔斯马尼亚健康纵向研究
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我们真的需要哮喘-慢性阻塞性肺疾病重叠综合征吗？
