COPD并发呼吸衰竭30例分析

目的总结分析慢性阻塞性肺疾病（COPD）并发呼吸衰竭的原因、急救经验和教训。方法回顾性收集2005年1月-2006年12月期间住院的COPD并发呼吸衰竭的临床资料。结果30例COPD并发呼吸衰竭病例，血白细胞升高22例（22／30），分别并发肝或肾功能障碍（12例）、消化道出血（3例）、电解质紊乱（7例）、呼吸性酸中毒（23例）、代谢性酸中毒（8例）或呼吸性碱中毒（7例）。24例经常规抗感染、抗结核、吸氧、解痉平喘、化痰止咳等保守治疗均获成功，无效者行机械通气及纤支镜吸痰、支气管肺泡灌洗治疗6例，无效3例。死因为通气机相关性肺炎、高气压伤、感染性休克、DIC、顽固性心衰、严重电解质紊乱或耐多药肺结核等。结论肺部感染、肺结核明显加重COPD及呼吸衰竭，常规治疗及结合机械通气、纤支镜吸痰、支气管肺泡灌洗及根据痰或支气管肺泡灌洗液行细菌培养及药敏试验选用抗生素治疗有效率高达90％，但预防机械通气相关并发症是提高COPD并严重呼衰救治成功率的关键，COPD并耐多药结核病患者发生的呼吸衰竭经机械通气救治的死亡率仍较高（50％）。

30-case report and the analysis of COPD complicated with respiratory failure

Objective To summarize the cause of chronic obstructive pulmonary disease complicating respiratory failure and the experience and lessen in the emergency treatment. Methods Clinical data of the inpatients suffered from COPD complicating respiratory failure were collected from January 2005 to December 2006. Result The total number of white blood ceils in the blood from 20 of 30 cases of COPD complicating respiratory failure excessed normal level. The syndrome was liver or renal dysfunction（ 12 cases）, digestive tract hemorrhage （ 3 cases）, electrolytical turbulence （7 cases）, respiratory acidemia （ 23 cases ）, metabolic acidemia （ 8 cases）, or respiratory alkalemia（7 cases）, respectively. Twenty-four inpatients were cured by conservative routine antimicrobial, antituberculous, oxygen supplementation, bronchodilation, mucolytic therapy. 6 cases who were not fully responsive to routine treatment were mechanically ventilated. Then secretion aspiration,bronehoalveolar washing and lavage by fiberoptic bronchoscopy were performed. Three cases died from ventila- tion-asseeiated pneumonia, high air pressure injure,infectious shock, disseminated intmvaseular coagulation, obstinate heart failure, severe electrolytical turbulence, or drug-resistant pulmonary tuberculosis. Conclusion Pulmonary infection and tuberculosis could aggravate chronic obstructive pulmonary disease complicating respiratory failure. High effective rate （90%） is observed in the inpatients with chronic obstructive pulmonary disease complicating respiratory failure by routine treatment, mechanical ventilation, secretion aspiration, bmnehoal- veolar washing and lavage by fiberoptic bronchoscopy and antimicrohial treatment by germiculture and drug susceptibility test of suptum or bronchoalveolar lavage liquid. It is very important for the improvement of successful treatment of COPD complicating respiratory failure by preventing the development of syndrom from mechanical ventilation. But noted is the high death rate （ 50% ） ob