慢性阻塞性肺疾病致急性呼吸衰竭的危险因素分析

Analysis of the risk factors of chronic obstructive pulmonary disease combined with acute respiratory failure

目的探讨慢性阻塞性肺疾病(COPD)致急性呼吸衰竭的危险因素,为临床防治策略的制订提供理论依据。方法回顾性分析本院收治的136例COPD患者的临床资料,将48例并发急性呼吸衰竭的患者分为呼吸衰竭组,88例未并发急性呼吸衰竭的患者分为无呼吸衰竭组。呼吸衰竭组患者中,15例死亡者为死亡组,33例康复出院者为康复组。通过收集所有患者的各项临床资料,对比呼吸衰竭组和无呼吸衰竭组,康复组和死亡组的临床资料,分析COPD致急性呼吸衰竭的危险因素。结果呼吸衰竭组患者体质指数(BMI)为(20.29±1.01)kg/m2,每年发生COPD急性发作(AECOPD)次数为(5.64±1.09)次,极重度COPD比例为66.67%,发生酸碱平衡紊乱的比例为77.08%,均显著高于无呼吸衰竭组(P均<0.05)。呼吸衰竭组患者使用吸入性糖皮质激素的比例为35.42%,尿酸水平为(268.69±71.55)mmol/L,白蛋白水平为(29.21±1.09)g/L,均显著低于对照组(P均<0.05)。死亡组患者pH为(7.22±0.05),血钠水平为(130.06±2.54)mmol/L,血氯水平为(90.38±2.42)mmol/L,均显著低于康复组(P均<0.05)。死亡组患者血二氧化碳分压为(91.72±12.46)mmHg,血糖水平为(6.48±1.46)mmol/L,100%并发肺性脑病和心力衰竭,均显著高于康复组(P均<0.05)。结论营养状况、AECOPD发作次数、使用吸入性糖皮质激素、水电解质和酸碱平衡的调节均是COPD致急性呼吸衰竭的相关因素。

Objective To analyse the risk factors of chronic obstructive pulmonary disease（COPD） combined with acute respiratory failure, and to provide theoretical evidence for clinical prevention and treatment strategies. Method The clinical data of 136 patients with COPD in our hospital was retrospectively analyzed, 48 patients with acute respiratory failure were divided into respiratory failure group, 88 patients without acute respiratory failure were divided into no respiratory failure group. In respiratory failure group, 15 cases of death in the death group, 33 cases in rehabilitation group. The clinical data of each group was collected and compared, and the risk factors of acute respiratory failure caused by COPD were analyzed. Result The BMI for respiratory failure group was（20.29±1.01） kg/m^2, AECOPD frequency was（5.64±1.09） times, with COPD ratio of 66.67%, occurred in acid-base ratio of 77.08%, they were significantly higher than those of non respiratory failure group（P〈0.05）. The ratio of using inhaled corticosteroids was 35.42%, uric acid level was（268.69±71.55） mmol/L, albumin level was（29.21±1.09） g/L in respiratory failure group, were significantly lower than those in the control group（P〈0.05）. pH value was（7.22±0.05）, serum sodium level was（130.06±2.54） mmol/L, blood chlorine levels（90.38±2.42） mmol/L in death group, were significantly lower than those in the rehabilitation group（P〈0.05）. The partial pressure of carbon dioxide was（91.72±12.46） mmHg, blood glucose level was（6.48±1.46） mmol/L, 100% patients with pulmonary encephalopathy and heart failure in the death group, were significantly higher than those in the rehabilitation group（P〈0.05）. Conclusion The nutritional status, AECOPD episodes, use of inhaled corticosteroids, regulation of water electrolyte and acid-base balance were related factors of acute respiratory failure caused by COPD.