老年慢性阻塞性肺疾病合并慢性心力衰竭的诊治进展

The Advance of Diagnosis and Therapy on Elderly Patients with Coexistence of COPD and CHF

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)和慢性心力衰竭(chronic heart failure,CHF)的患病率随着年龄增大而增加。在老年患者中,COPD和CHF合并存在十分常见,但是通常被忽视。对于COPD患者,为了避免忽视CHF的存在,也应该常规评估左室功能。同样,对于CHF患者,为了避免忽视COPD的存在,应该常规检查肺功能试验。在COPD的患者中,血浆脑钠肽水平对于诊断合并CHF是有帮助的。骨骼肌代谢变更和萎缩,是导致老年CHF和COPD患者机体能力迅速衰退共同的机制。与传统观念相反,CHF和COPD共存的患者应该给予长期的β受体阻断剂。运动训练可快速逆转骨骼肌代谢更迭和萎缩的进程,促使老年患者独立,并提高生活质量。

The prevalence of obstructive pulmonary disease （COPD） and chronic heart failure （CHF） increased gradually with age. The coexistence of COPD and CHF was very common but often neglected. To avoid overlooking COPD in patients with known CHF, pulmonary function tests should be routinely obtained. Likewise, to avoid overlooking CHF in patients with known COPD, left ventricular function should be routinely assessed. Plasma brain natriurctic pcptide was a useful index to differentiate COPD exacerbation from CHF decompensation in patients presenting with acute dyspnea. Skeletal muscle metabolic alterations and its atrophy were the common mechanisms which resulting in deterioration of function capacity in elderly patients with CHF and COPD. Contrary to the conventional belief, long-term beta adrcnergic blockers should be given to elderly patients with CHF and COPD. Exercise training reverses rapidly progress of skeletal muscle metabolic alterations and atrophy and promotes independence and life quality in elderly patients.