慢性阻塞性肺疾病“临界呼吸衰竭”的研究

A study of patients in status of “interface respiratory failure” due to chronic obstructive pulmonary diseases

目的提出并解释由慢性阻塞性支气管炎导致的慢性阻塞性肺疾病(COPD)老年患者病情发展的一个特定阶段“临界呼吸衰竭”。方法将该人群样本同未到达“临界呼吸衰竭”的COPD老年患者和老年正常对照组受试者做比较,研究其血气指标、静息呼吸驱动、气道阻力与顺应性、白介素4、γ干扰素以及它们之间的相互作用及其作用强度。结果已达到“临界呼吸衰竭”的COPD老年患者较之未到达“临界呼吸衰竭”的COPD老年患者和老年正常对照组受试者在血气指标、静息呼吸驱动、气道阻力与顺应性、白介素4和γ干扰素方面均会导致病情进一步恶化,表明“临界呼吸衰竭”这一定义具有一定的临床指导意义。结论对“临界呼吸衰竭”这一阶段的人群应在其发展至呼吸衰竭以前及时给予适当干预。如吸氧、应用气道扩张药物、改善气道顺应性以及免疫治疗和抗感染治疗等。

Objective To submit and explain a definition of ＂interface respiratory failure＂ as arterial blood gas assay with arterial oxygen partial pressure in the range of ≥60mmHg and 〈75mmHg. Methods We measured and compared arterial blood gases, peaceful respiratory drive and its derivatives, mechanics of respiratory muscles, resistance and compliance of respiratory tract and some important cytokines （interleukin-4 and interferon-γ） of stable chronic obstructive pulmonary disease（COPD） subgroups （till and until this special ＂interface respiratory failure＂ stage, both 25 cases） and control group （25 cases）,and then analyzed the statistical data with the software SPSS11. 5. Results The patients attained the ＂interface respiratory failure＂ stage developed great changes in respiratory mechanics parameters and inflammatory medium which might cause the exacerbation of COPD and inclined to generate ＂real respiratory failure＂ and COPD progress. Conclusions The definition is scientific, directive and its width is appropriate. We should intervene appropriately and positively to avoid progression from ＂interface respiratory failure＂ to ＂real respiratory failure＂ stage,and this avoidance means a higher survival rate and a lower expense of medical resource. Interventions should focus on oxygen therapy, bronchodilators, improving respiratory compliance, cytokines and anti-infective agents respectively.