老年COPD肺心病急性期多器官功能衰竭的临床特征

CLINICAL CHARACTERS OF ACUTE EXACERBATION WITH MULTIPLE ORGAN FAILURE IN THE ELDERLY PATIENTS WITH CHRONIC COR PULMONALE

目的 探讨老年COPD肺心病急性期多器官衰竭的临床特征。方法 回顾分析1993年1月—1999年1月收治的老年COPD肺心病所致MOFE患者119例的临床资料，结果 各器官衰竭的发生率依次为肺、心血管、脑、肾、肝、胃肠、血液。以肺和心血管发生率最高(均为100％)；总病死率345％；心、肺、脑、胃及心、肺、脑、肾分别同时衰竭的病死率为100％和80％．出现DIC者全部死亡。2、3、4、5个器官衰竭的病死率分别为8．9％，33．3％、73．9％和57．1％，6个及以上器官衰竭的病死率为100％；pH值越低，氧分压越低，二氧化碳分压短期内迅速上升或二氧化碳分压过度降低，衰竭器官数目越多，病死率越高。结论 老年肺心病MOFE发生初期应重点防治心、肺两个器官，病死率随着衰竭器官数目的增加而上升，与衰竭器官的种类、严重程度及抢救时机有关。

To observe the clinical characters of acute exacerbation with multiple organ failure in the elderly patients with chronic cor pulmonale. Methods 119 elderly patients of chronic cor pulmonale with multiple organ failures were reported. Results The morbidity of organ failure was in order of respiratory, cardiac, cerebral, renal, liver, gastrointestinal and blood. The highest morbidity was those of respiratory and cardiac (100%) . The overall mortality was 34.5% . The mortality of patients with respiratory, cardiac, cerebral and gastrointestinal failures at the same time or with respiratory, cardiac, cerebral and renal failures were 100% and 80% respectively. The patients with DIC died. The mortality of patients with 2,3,4,5 organ failures were 8.9%, 33. 3% , 73.9%, 57.1% respectively. The lower were pH and PaO2 or the higher was PaCO2, the higher was the mortality. Conclusions It is very important to improve the blood gases for reducing the morbidity of organ failures and for increasing the survival rate in the treatment of acute exacerbation in chronic cor pulmonale.