慢性阻塞性肺疾病急性加重期合并呼吸衰竭红细胞比容水平变化

Changes of Hematocrit in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated With Respiratory Failure

目的探究红细胞比容在慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者中的水平变化及临床意义。方法回顾性选取2017年3月至2019年3月我院呼吸与危重症医学科诊断为慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭住院患者共149例,收集入选者入院时红细胞比容(HCT)、D二聚体(D-D)、C反应蛋白(CRP)、住院时间(T)及动脉血气结果(PO2、PCO2),按呼吸衰竭类型将其分为AECOPD合并Ⅰ型呼吸衰竭组(a组65人)、AECOPD合并Ⅱ型呼吸衰竭组(b组84人);按是否合并社区获得性肺炎(Community acquired pneumonia,CAP)将所有入选者分为AECOPD合并肺炎组(c组84人)和AECOPD组(d组65人),分别比较a、b两组、c、d两组间HCT差异,分析HCT在AECOPD中的变化水平及临床意义。结果b组HCT、D-D、CRP、T均高于a组(P<0.05);c组HCT、D-D、PCO2、T均明显高于d组(P<0.05),而d组PO2明显高于c组(P<0.05);HCT与D-D、PCO2、CRP、T呈正相关(r=0.550,P<0.01;r=0.323,P<0.01;r=0.349,P<0.01;r=0.573,P<0.01),与PO2呈负相关(r=-0.222,P<0.01)。结论在AECOPD合并呼吸衰竭患者中,不同呼吸衰竭类型HCT水平存在差异,且HCT变化与AECOPD是否合并CAP有关,提示HCT能反映AECOPD组织缺氧、二氧化碳潴留、炎症反应程度及凝血指标变化,有助于病情近期预后评估。

Objective Study on the level and clinical significance of erythrocyte specific volume(HCT)in patients with(AECOPD)complicated with respiratory failure in acute exacerbation of chronic obstructive pulmonary disease.Methods A total of 149 inpatients with AECOPD complicated with respiratory failure diagnosed in the department of respiratory and critical medicine in our hospital From March 2017 to March 2019 were selected retrospectively.the results of HCT,DD,CRP,Length of stay in hospital(T)and arterial blood gas were collected and divided into AECOPD with typeⅠrespiratory failure group(group a,n=65)and AECOPD with typeⅡrespiratory failure group(group b,n=84).According to whether or not was complicated with community acquired pneumonia(CAP),the patients were divided into AECOPD with pneumonia group(group c,n=84)and AECOPD group(group d,n=65).The differences of HCT between group a and group b,group c and group d were compared,and the level and clinical significance of HCT in AECOPD were analyzed.Results The levels of HCT,DD,CRP and T in group b were significantly higher than those in group a(P<0.05);and the levels of HCT,DD,PCO2 and T in group c were significantly higher than those in group d(P<0.05),while the PO2 in group d was significantly higher than that in group c(P<0.05).There was a positive correlation between HCT and DD,PCO2,CRP and T(r=0.550,P<0.01;r=0.323,P<0.01;r=0.349,P<0.01;r=0.573,P<0.01),and negatively correlated with PO2(r=-0.222,P<0.01).Conclusion In patients with AECOPD,the level of HCT is different in different types of respiratory failure.The change of HCT is related to whether AECOPD is complicated with CAP,suggesting that HCT can reflect the changes of hypoxia,carbon dioxide retention,inflammatory reaction and coagulation indexes in AECOPD,which is helpful to evaluate the short-term prognosis of AECOPD.