老年慢性阻塞性肺疾病急性加重期并发呼吸衰竭预后相关因素

目的通过回顾性统计分析46例老年AECOPD并发呼吸衰竭患者的病史（1年内发生AECOPD并发呼吸衰竭次数）、入院时的生命体征（T、R、P、BP、SaO2）、实验室资料（PH、PaO2、PaCO2、WBC）、主要临床合并症（心力衰竭、上消化道出血、肝肾功能损害、肺脑、酸碱平衡紊乱）及无创和有创通气治疗效果，探讨其对判断病情及预后的意义，通气治疗手段的选择。方法将收治的46例老年AECOPD并发呼吸衰竭患者按病情转归分为好转组24例和死亡组22例。对两组1年内发生AECOPD并发呼吸衰竭次数、两组4大生命体征（T、R、P、BP）及Sa（h、两组实验室资料（pH、PaO2、PaCO2、WBC）、两组主要合并症（心力衰竭、上消化道出血、肝肾功能损害、肺脑、酸碱平衡紊乱）、无创和有创通气治疗效果，进行统计学分析比较及百分比分析比较。结果死亡组1年内发生AECOPD并发呼吸衰竭3次以上的百分率较好转组明显增高；死亡组与好转组T、R、P、BP、SaO2（％）比较均有显著差异（P〈0．05、P〈0．01、P〈0．01、P〈0．01、P〈0．05）：死亡组与好转组PaO2无明显差异（P〉0．05），但pH、PaCO2及外周血WBC有显著差异（P〈0．01、P〈0．01、P〈0．05）；心力衰竭、上消化道出血、肝肾功能损害、肺脑、酸碱平衡紊乱的发生率在死亡组明显增高，肺脑、酸碱平衡紊乱的发生率在死亡组达到100％，合并症发生率比较死亡组明显高于好转组；无创性机械通气治疗好转率83．33％；有创机械通气治疗死亡率60．00％，其中83．33％合并呼吸机相关性肺炎。结论1年内发生AE-COPD并发呼吸衰竭3次以上，死亡率明显增高；T、R、P、BP、SaO2（％）、pH、外周血WBC、PaCO2异常越明显，预后就越差；病情的进展，可导致多脏器功能衰竭；早期无创性机械通气治疗可作为老年AECOPD并发呼吸衰竭的重要手段，有创?

Prognostic Relative Factor of Aged COPD Combined with Respiratory Failure

Objective To discuss the therapenutic efficacy with invasive and non-invasive ventilation and to retrospectively evaluate the prognosis selection of ventilation through the analysis of failure history,vital signs when hospitalized,lab test and clinical symptoms.Methods 46 cases of such patient were divided into recovery group 24 cases and dead group 22 cases according to the prognosis.The failure times,vital signs,lab test,main complications,ventilation types were analyzed and statistics was taken in comparison within 1 year.Results There were significant differences in respiratory failure times,vital signs,complications,and incidences of disorder of other systems in two groups but PaO2.The non-invasive recovery rate was 83.33%,invasive ventilation death rate was 60% and among them 83.33% was related with ventilated related pneumonia.Conclusion The bad prognosis was related with the failure times,vital signs unstable and complications.The early non-invasive ventilation might be effective for AECOPD and high death rate of invasive ventilation might be related with pneumonia.