老年人慢性肺心病合并呼吸衰竭致上消化道出血的原因及治疗  

Factors of upper Gastrointestinal Henwrrhage in Old Patients with Respiratory Failure due to Chronic Cor pulmonale and the Contributing of Noninvasive Mechanical Ventilation

作　　者：赵苏[1] 杨钢[1] 徐惠敏[1] 

机构地区：[1]湖北省武汉市中心医院呼吸内科,湖北武汉430014

出　　处：《中国临床医学》2006年第4期566-568,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨老年人慢性肺心病并呼吸衰竭时发生上消化道出血的原因及无创通气对其的影响。方法:老年人慢性肺心痛并呼吸衰竭发生上消化道出血48例(治疗组),分别与非上消化道出血的肺心病呼吸衰竭(呼衰非出血组)和非肺心病呼吸衰竭的上消化道出血(普通出血组)对照。并将治疗组随机分组,一组予以药物治疗(对照组),另一组在药物治疗基础上加无创通气治疗(呼吸机组)。结果:治疗组以急性胃粘膜病变为主要出血原因,在预测出血前症状上,与普通出血组无显著差异,但在伴随基础疾病(伴同病)及并发症方面与其有显著差异;与呼衰非出血组比较,动脉血pH≤7.20, PaO2<5．53 kPa,PaCO2>10 kPa,呼酸+代酸,以及Cr>221．5μmol／L等项指标均有显著差异,发生多器官功能衰竭明显多于呼衰非出血组。呼吸机组病死率为29.1％(7／24);对照组病死率为45．8％(11／24)。结论:从症状上要仔细分析出血先兆,严密监测动脉血气、血肌酐等指标变化,严重酸中毒是导致上消化道出血的危险因素,伴同病多使治疗困难,因此治疗上特别强调治疗伴同病和防治多器官功能衰竭的重要性,无创通气治疗可有效降低肺心痛呼吸衰竭并发上消化道出血的病死率。Objective：To study the contributing and protective factor of upper gastrointestinal hemorrhage after noninvasive mechanical ventilation（NIMV）on old patients with respiratory failure due to chronic cor pulmonale. Methods：48 patients suffered from respiratory failure due to cot pulmonale with upper gastrointestinal hemorrhage were enrolled in our hospital during last 7 years. They were divided into treatment group and control group with two other groups. In group A, the patients were complicated with respiratory failure and non-hemorrhage. In group B, the patients were complicated with hemorrhage and nonrespiratory failure. The patients in control group received drugs treatment and other patients in treatment group received NIMV based on drug treatment. Results：Stress ulcer was an major risk factor of hemorrhage on the patients with hemorrhage and respiratory failure. The symptoms before hemorrhage were not different from group B But the complication and company diseases were significant different from group B. The indicators such as arterial blood gas pH〈7. 20, PaO2〈5.53KPa,PaCO2 10kPa,respiratory acidosis＋metabolic acidosis and Cr〉221.5μmol/L, were quite different in group A. There were less multiple system organ failure in group A. The mortality was 29. 1% （7/24）in treatment group and 45.8% （11/24）in control group. Concluslon：It is very important to analyze the symptom before hemorrhage and observe the change of arterial blood gas and Cr. Severe acidosis is a risk factor for upper gastrointestinal hemorrhage. It plays a key role to control the company disease and multiple system organ failure. The treatment of NIMV can effectively reduce the mortality of upper gastrointestinal hemorrhage in patient with respiratory failure due to cor pulmonale.

关 键 词：无创机械通气 肺心病 呼吸衰竭 上消化道出血 

分 类 号：R645.2[医药卫生—外科学]