成年新型冠状病毒Delta变异株感染患者延迟出院相关因素分析  

Factors associated with delayed discharge from hospital in adult COVID-19 patients infected with Delta variant

作　　者：林勤清 何国军[1] 姚亚克 周华[1] LIN Qinqing;HE Guojun;YAO Yake;ZHOU Hua(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;不详)

机构地区：[1]浙江大学医学院附属第一医院呼吸与危重症医学科,杭州310006 [2]绍兴文理学院附属医院重症医学科

出　　处：《浙江医学》2022年第20期2208-2212,共5页Zhejiang Medical Journal

基　　金：浙江省卫生健康委省部共建重大项目(WKJ-ZJ-2109)。

摘　　要：目的探讨影响成年新型冠状病毒Delta变异株感染的新型冠状病毒肺炎(COVID-19)患者延迟出院的相关因素。方法收集2021年12月至2022年2月在绍兴文理学院附属医院中心院区住院治疗的成年新型冠状病毒Delta变异株AY.4进化分支毒株感染的COVID-19患者281例。根据患者是否超过中位住院时间分为延迟出院组(住院时间超过中位住院时间)152例和对照组(住院时间少于中位住院时间)129例。比较两组患者一般情况、临床表现、实验室检查指标、肺部CT表现、药物治疗情况及核酸转阴时间,采用多因素logistic回归分析影响COVID-19患者延迟出院的危险因素。结果所有患者住院时间8~49 d,中位住院时间26.0(22.0,29.0)d;延迟出院组患者中位住院时间29.0(27.0,31.0)d,对照组患者中位住院时间22.0(21.0,24.0)d。延迟出院组患者年龄、糖尿病比例、普通型患者比例、肌痛比例、高热比例、D-二聚体升高比例、CRP水平、有新型冠状病毒感染肺部CT表现的比例、抗菌药物使用比例、中药使用比例、静脉注射免疫球蛋白比例、皮下注射胸腺肽比例均高于对照组,核酸转阴时间长于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示高龄(OR=1.023,95%CI:1.004~1.044,P<0.05)、合并糖尿病(OR=4.883,95%CI:1.589~15.003,P<0.05)和肌痛(OR=7.368,95%CI:1.439~37.731,P<0.05)均是影响患者延迟出院的独立危险因素。结论COVID-19患者住院时间差异较大,影响因素较多。高龄、肌痛、合并糖尿病是延迟出院的独立危险因素,临床需重视此类患者的观察和治疗。Objective To explore the related factors of delayed discharge from hospital in adult COVID-19 patients infected with Delta variant.Methods A total of 281 adult COVID 19 patients infected with Delta variant AY.4 admitted in Central Hospital Affiliated to Shaoxing College of Arts and Sciences from December 2021 to February 2022 were enrolled.According to whether the patients exceeded the median hospital stay or not,they were divided into delayed discharge group(more than the median hospital stay)(152 cases)and control group(less than the median hospital stay)(129 cases).The general conditions,clinical manifestations,laboratory test indicators,chest CT findings,drug treatment and negative converting time of nucleic acid tests of the two groups were compared.Multivariate logistic regression analysis was used to analyze the risk factors affecting delayed discharge of COVID-19 patients.Results The length of hospital stay was 8~49 d with a median of 26(22.0,29.0)d.The median length of hospital stay in delayed discharge group was 29.0(27.0,31.0)d and that of control group was 22.0(21.0,24.0)d.The age of patients,comorbid diabetes mellitus,the proportion of patients with common type,symptoms of myalgia and fever,increased D-dimer and CRP levels,positive pulmonary CT findings,administration of antibacterial drug,traditional Chinese medicine,intravenous immunoglobulin and thymosin in the delayed discharge group were higher than those in the control group;the negative converting time of nucleic acid tests was longer than that of the control group(all P<0.05).Multivariate logistic regression analysis showed that advanced age(OR=1.023,95%CI:1.004-1.044,P<0.05),comorbid diabetes mellitus(OR=4.883,95%CI:1.589-15.003,P<0.05)and myalgia(OR=7.368,95%CI:1.439-37.731,P<0.05)were independent risk factors for delayed discharge.Conclusion The length of hospital stay of COVID-19 patients varies greatly,and the advanced age,myalgia symptom,comorbid diabetes mellitus are factors related to delayed discharge.

关 键 词：新型冠状病毒肺炎 住院时间 肌痛 糖尿病 高龄 

分 类 号：R563.1[医药卫生—呼吸系统]