Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya3290610.26442/00403660.2018.12.000011Editorial articleПередовая статьяResearch ArticleTreatment of exacerbations of chronic obstructive pulmonary diseaseЛечение обострений хронической обструктивной болезни легкихAvdeevS NАвдеевСергей Николаевич

д.м.н., проф., член-корр. РАН, зав. каф. пульмонологии Первого МГМУ им. И.М. Сеченова, зам. директора по научной работе, зав. клиническим отд. НИИ пульмонологии

TruschenkoN VТрушенкоНаталья Владимировна

к.м.н., ассистент каф. пульмонологии Первого МГМУ им. И.М. Сеченова, н.с. НИИ пульмонологии

GaynitdinovaV VГайнитдиноваВилия Вилевна

д.м.н., проф. каф. пульмонологии Первого МГМУ им. И.М. Сеченова

ivv_08@mail.ruSoeA KСоАунг Кьяв

аспирант РНИМУ им. Н.И. Пирогова

NuralievaG SНуралиеваГилия Сериковна

к.м.н., ассистент каф. пульмонологии Первого МГМУ им. И.М. Сеченова; н.с. НИИ пульмонологии

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)Pulmonology Research Institute of Federal Medico-Biological Agency of RussiaФГБУ «Научно-исследовательский институт пульмонологии» ФМБА РоссииN.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian FederationФГБОУ ВО «Российский научно-исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России151220189012VOL 90, NO12 (2018)ТОМ 90, №12 (2018)687511042020Copyright ©; 2018, Consilium MedicumCopyright ©; 2018, ООО "Консилиум Медикум"2018Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/32906

Chronic obstructive pulmonary disease (COPD) and its exacerbations remain an important problem of clinical medicine. Aim. To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. Materials and methods. The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients’ demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". Results and discussion. The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy - in 23,8% of patients, pulmonary rehabilitation - in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests - in 79.8%, blood gases analysis - in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. Conclusion. Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.

Хроническая обструктивная болезнь легких (ХОБЛ) и ее обострения остаются актуальной проблемой клинической медицины. Цель исследования: оценить качество медицинской помощи, оказываемой в крупных российских стационарах пациентам с обострением ХОБЛ. Материалы и методы. В исследование включены пациенты с обострением ХОБЛ, госпитализированные в стационар трех клинических больниц г. Москвы. Диагноз «обострение ХОБЛ» устанавливался в соответствии с клиническими рекомендациями. У всех пациентов собирались сведения о демографических показателях, симптомах заболевания, показателях газового анализа крови, рентгенографии органов грудной клетки (ОГК), медикаментозной терапии, кислородотерапии и проводимой респираторной поддержке. Период наблюдения составил 90 дней. Полученные данные сравнивались с данными пациентов из мультицентрового исследования «European COPD Audit». Результаты и обсуждение. Ведущими клиническими симптомами при обострении ХОБЛ являлись, как и в других странах, усиление одышки (95,4%) и увеличение объема мокроты (60,7%). Во время обострения большинство больных ХОБЛ получали короткодействующие β2-агонисты (77,4%), системные глюкокортикостероиды (85,1%), антибиотики (79,0%) и теофиллины (48,1%). Неинвазивную вентиляцию легких проводили у 8,6% пациентов, кислородотерапию - у 23,8% пациентов, легочную реабилитацию - лишь у 6,2% пациентов. Рентгенография ОГК выполнена у 97,9% пациентов, спирография - у 79,8%, исследование газов артериальной крови - у 19,3% пациентов. Средняя длительность госпитализации составляла 18,2±3,9 сут, повторные госпитализации в течение 90 дней - у 36,2% пациентов. Внутрибольничная летальность составила 3,3%. Заключение. На основании результатов проведенного исследования предложены практические рекомендации по улучшению качества медицинской помощи при обострении ХОБЛ.

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