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急性加重(AECOPD)的临床特征及治疗。方法对2004年9月至2005年9月期间本院住院的52例60岁以上老年人AECOPD的临床资料进行回顾分析。结果入院原因有咳嗽增加49例、气促加重47例、痰变脓性23例、痰量增加40例、发热12例等。45例合并1～3种以上其它脏器的病变。使用抗生素治疗者50例,多为二联抗生素,根据经验用药或根据痰培养药敏用药;使用茶碱类者46例;使用糖皮质激素联合吸入Β2受体激动剂及抗胆碱药者44例。结论老年人呼吸系统解剖生理学改变以及呼吸道防御功能下降易使呼吸道反复感染,这可能是老年AECOPD增加的原因;治疗上除了常规抗感染、茶碱类药平喘治疗外,宜根据病情联合应用糖皮质激素、Β2受体激动剂、抗胆碱药物等;此外,应同时注意其它脏器病变的治疗以及防治功能衰竭。

Clinical Analysis of Elderly Patients of Chronic Obstructive Pulmonary Disease with Acute Exacerbation

Objectives To explore the clinical characteristic and treatment of AECOPD (Chronic Obstructive Pulmonary Disease with Acute Exacerbation ) in elderly patients. Methods The clinical data of 52 cases of AECOPD in elderly patients (age>60)admitted to our hospital during Sep. 2004 and Sep. 2005 were analyzed retrospectively.Results The reasons for hospitalization were 49 cases of increased cough, 47 case of worsened rabid breathing, 40 cases of increased sputum, 23 cases of yellowish sputum and 12 cases of fever. Among the 52 cases of AECOPD, there were 45 cases combined with 1 to 3 cases of other organ diseases.50cases patients were treated with antibiotics, most of which were combined antibiotics. The patients were administered according to the physicians' experience and the sputum culture and drug sensibility trials; 46 cases were given theophylline;38 cases were given glucocorticoid ;44 cases were given beta 2 receptor agonist and anticholinergic.Conclusions The change of anatomical physiology of respiratory system and the decline of resistance function of respiratory tract of elderly patient would easily cause repeated infection in respiratory tract. This may contribute to AECOPD. Apart from using anti-infective and theophylline treatment, thecombined use of glucocorticoid, beta 2 receptor agonist and anticholinergic, etc. according to the disease conditions should be adopted. Attention should be paid to the management of other organ diseases and the prevention and treatment of function failure.