急性慢性阻塞性肺疾病并发呼吸衰竭行机械通气对预后的影响  

Affection on Prognosis of AECOPD Combined with Respiratory Failure Ventilation

作　　者：唐正梁[1] 尹虹雷[1] 

机构地区：[1]黑龙江省医院南岗院区呼吸内科,黑龙江哈尔滨150001

出　　处：《黑龙江医学》2009年第4期249-251,共3页Heilongjiang Medical Journal

摘　　要：目的通过回顾性分析急性慢性阻塞性肺疾病(AECOPD)并发呼吸衰竭患者的病史、入院时的生命体征、实验室资料、主要临床合并症及无创和有创通气治疗效果,探讨预后的相关因素及其通气治疗的效果。方法将本文收治的52例AECOPD并发呼吸衰竭患者按病情转归分为好转组27例和死亡组25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SaO2、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①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;②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);③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);④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;⑤无创性机械通气治疗好转率83.33%;有创械通气治疗死亡率60.00%,其中83.33%合并呼吸机相关性肺炎。结论①1年内发生AECOPD并发呼吸衰竭3次以上死亡率明显增高;②T、R、P、BP、SaO2(%)、pH、外周血WBC、PaCO2异常越明显,预后就越差;③病情的进展,可导致多脏器功能衰竭;④早期无创性机械通气治疗可作为AECOPD并发呼吸衰竭的重要手段,有创械通气治疗死亡率高与合并呼吸机相关性肺炎有关。Objective To discuss the relative factors and ventilation curative effect. Methods The clinical materials of 52 cases of such patient were analyzed retropsectively for AECOPD combined with RF in history （times）, vital signs （T, R, P, BP）, lab data（ pH, PaCO2, WBC）, clinical manifestation, complication （HF, Upper digestive bleeding, liver and kidney injury, pulmonary cephalopathy and disturbance of acid - base balance） and ventilation therapy effects within 1 year.They were divided into 2 groups in improved group （27 cases） and death group （25 cases）.The data was stastically analyzed. Results The ratio of over 3 times RF in death group was higher than that in improved group. There were significant difference in two groups in vital signs as well as pH and WBC but not in PaO2.The incidence of I-IF, UDB, liver and kidney injury, PC in death group were mcuh higher than those in improved group. The improved rate of non - invasive ventilation was 83.33 % and of invasive ventilation was 60.00% that was relative pneumonia in 83.33 %. Conclusion The death rate in patient who had over 3 times RF was higher. The abnormal of T, R, P, BP, SaO2（ % ）, pH, WBC,PaCO2 might had bad prognosis.The progression might cause MOF. The early non- invasive ventilation might be important method for AECOPD combined with RF. The mortality of invasive ventilation might be related with the relative pneumonia.

关 键 词：急性慢性阻塞性肺疾病 呼吸衰竭 机械通气 

分 类 号：R563[医药卫生—呼吸系统]