100例老年慢性阻塞性肺疾病急性加重的临床分析

目的 探讨老年慢性阻塞性肺疾病(COPD)急性加重的发生，发展及治疗。方法 2003年9月到2004年2月，我院65岁以上的老年COPD急性加重的住院患者。结果 100例中合并慢性肺源性心脏病59例、冠心病17例、原发性高血压41例、合并高血压性心脏病12例、糖尿病14例、老年瓣膜性心脏病7例；发生心衰52例、呼吸衰竭37例、肾功能不全23例、肝功能不全8例、心律失常7例；其中合并1种其他脏器病变的患者24例，合并2种其他脏器病变的患者33例，合并3种及3种以上其他脏器病变的患者37例；死亡8例。合并1种其他脏器病变(1例)12．5％，合并2种其他脏器的病变(2例)25％，合并3种及3种以上其他脏器的病变(5例)62．5％；死亡组与非死亡组患者入院时的血白细胞，动脉血气等实验室指标比较，统计测定显著性差异。结论 老年呼吸道防御功能下降招致的呼吸道反复感染，可能是老年人COPD发病率增加的原因；老年COPD病患者多合并呼吸，心脏和其他脏器的病变；急性加重患者的处理，应在积极抗感染的同时注意其他脏器合并症和功能衰竭的治疗。

Analysis of 100 elderly patients of chronic obstructive pulmonary disease with acute exacerbation

Objective To explore the occurrence, development and treatment methods for chronic obstructive pulmonary disease with acute exacerbation in elderly patients. Methods The study sample included 100 elderly patients (age>65) admitted to our hospitals who had chronic obstructive pulmonary disease with acute exacerbation. Results The distribution of the complications in the sample was as follows: 59 cases complicated with chronic pulmonary heart disease, 17 with coronary heart disease, 14 with original hypertension, 12 with hypertensive heart disease, 14 with diabetes, 7 with senile valvular heart disease, 52 suffering from heart failure, 37 from respiratory failure, 23 from renal failure, 8 from hepatic failure, and 7 with arrhythmia. There were 24 cases with 1 other organ disease, 33 cases with 2 other organ diseases, 37 with 3 or more other organ diseases. There were 8 cases of death reports. Among them, 1 case was complicated with 1 other organ disease, 2 cases with 2 other organ diseases and 5 cases with three or more other organ diseases. There's no significant difference in the white blood cell count and artery gas analysis between the death and the survival group.Conclusion Recurrent respiratory infection due to anatomical and defense factors may be the cause for the increase of chromic obstructive pulmonary disease in elderly patients. Elderly patients with chronic obstructive pulmonary disease are apt to complicate with respiratory, cardiac and other organ diseases. The disease management must include the treatment of other organ diseases and of function failure besides antibiotic therapy.