慢性阻塞性肺病患者伴发呼吸道感染的诊断和治疗——附101例临床分析

Diagnosis and Treatment of Chronic Obstructive Pulmonary Diseases Complicated with Acute Infection: Analysis. of 101 Cases

慢性支气管炎和阻塞性肺气肿伴或不伴肺心病(简称慢阻肺病)病人,常因急性呼吸道感染诱发呼吸衰竭或/和心力衰竭,导致死亡。本文通过对两年来住院的101例慢阻肺的病例分析,探讨伴发呼吸道感染的早期诊断和更有效的治疗等问题,希望能对今后的临床工作有所俾益。

This series comprised 101 patients(50 men and 51 women)with an average age of 61 years.All of the patients had a history of chronic cough and asthmatic breath for many years(19.1 years in average),most of them complicated with cor pulmonale.The incidence of acute respiratory infection of these patients is highest in the winter season(40.5%),espicially in January and February.The manifestations of complicated infection are not entirely the same as what considered traditionally.Only 45 cases(44.5%)had body temperature above 37℃,the rest are afebrile.Leucocytosis of various degree had been found in only 55 cases(54.4%).Only 39 cases(38.6%)expectorated yellowish purulent sputum;the remainder(61.4%)expectorated either whitish mucoid or frothy sputum.Therefore,the diagnosis of acute respiratory infection in patients with COPD shouldn’t depend merely up on the presence of fever,leucocytosis and grossly purulent expectorations.Meanwhile,the sudden worsening of cough and shortness of breath,increase of amount of sputum and drowsy appearance should be considered as indications of this complication.From the result of sputum cultures,it is recognized that the kind of causative organisms isolated is rather complex;there are not only gram-positive cocci and gram negative cocci,but also gram-negative baccilli,the latter probably playing a more significant role.As such,clinicians must be very enthusiastic about controlling the infection.Early administration of broad spectrum antibiotics is advisable.Two antibiotic used in combination always give a better effect.In this series,there are 22.8%of patients the infection was controlled in the first 3 days and 81.8%of patients controlledwithin 2 weeks.It should be emphasized that the possibility of antagonism between drugs must be kept in mind and avoided when two antibiotics are used in combination.