AECOPD老年患者呼吸衰竭的发生情况及其影响因素研究

Study on the incidence and influencing factors of respiratory failure in elderly patients with AECOPD

目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)老年患者发生呼吸衰竭的影响因素。方法:收集2015年至2018年在我院老年医学科住院的85例AECOPD老年患者的临床资料进行回顾性分析。根据血气分析结果的氧分压低于60 mm Hg、伴或不伴有二氧化碳分压高于50 mm Hg的标准,分为呼吸衰竭组35例和单纯AECOPD组50例,检测两组患者的血浆脑钠肽(BNP)、C反应蛋白水平及中性粒细胞计数,采用独立样本t检验、单因素方差分析、Logistic回归分析等方法进行数据分析。结果:85例患者中有35例发生呼吸衰竭,发生率为41.18%。呼吸衰竭组的年龄、C反应蛋白和血浆BNP水平、中性粒细胞计数显著高于单纯AECOPD组,差异均有统计学意义(均P<0.05)。且呼吸衰竭组过去一年AECOPD发作>2次、有2种以上合并症比例也高于单纯AECOPD组,差异有统计学意义(均P<0.05)。Logistic分析显示,年龄、血浆BNP水平是AECOPD老年患者发生呼吸衰竭的独立危险因素。结论:AECOPD老年患者发生呼吸衰竭的危险因素为高龄、合并症多,并且血浆BNP是预测呼吸衰竭发生的独立危险因子,对AECOPD老年患者发生呼吸衰竭的预防、诊断和治疗有一定的指导价值。

Objective:To explore the risk factors of respiratory failure with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the elderly.Methods:A retrospective study was conducted by collecting the data of patients in the geriatric department of the Ninth People’s Hospital in Suzhou from 2015 to 2018.85 people were selected after exclusion of acute cardio-cerebrovascular disease,autoimmune diseases,tumor,infection,severe liver and kidney dysfunction and other diseases.According to partial pressure of oxygen was lower than 60 mm Hg,with or without partial pressure of carbon dioxide higher than 50 mm Hg,they were divided into respiratory failure group(35 cases)and the pure AECOPD group(50 cases).Plasma brain natriuretic peptide(BNP),C-reactive protein(CRP)and neutrophil count were tested.Independent sample t-test,correlation analysis and Logistic regression analysis were used for data analysis.Results:Among the 85 patients,35 cases had respiratory failure(41.18%).The age,CRP,BNP and neutrophil count of respiratory failure group were higher than those of pure AECOPD group.The results also showed that more than twice AECOPD episodes in the past year and more than two kinds of complications were higher in respiratory failure group.The differences were statically significance difference(P<0.05).Logistic regression analysis showed that age and plasma BNP were independent risk factors for respiratory failure in AECOPD.Conclusion:The risk factors of respiratory failure in elderly patients with AECOPD are old age and many complications.Moreover,plasma BNP is an independent risk factor to predict the occurrence of respiratory failure,which has guiding value for the prevention,diagnosis and treatment of elderly patients with AECOPD.