影响慢性阻塞性肺疾病患者预后因素的探讨

Investigation of factors affecting the development of COPD

目的探讨影响慢性阻塞性肺疾病（ＣＯＰＤ）患者预后的因素。方法对１９７７年７月～１９９２年６月住院的８８例ＣＯＰＤ患者进行５～２０年随访。８８例患者中吸烟者占７７％，从事厨房劳动女性１３％。首诊均经右心漂浮导管检测，肺动脉平均压（ｍＰＡＰ）＜２０ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）。在随访期进行肺通气功能、血压、心电、血流动力学、夜间动脉血氧饱和度（ＳａＯ２）等监测，每５年重复一次。结果２０年随访共死亡３８例，病死率５年为６％、１０年为２５％、２０年为４３％。肺通气功能及动脉血氧分压逐年下降，二氧化碳分压逐年上升，首诊时ｍＰＡＰ为１６～２０ｍｍＨｇ的４１例中，１０年随访复查２０例ｍＰＡＰ＞２０ｍｍＨｇ，１５例死亡。夜间ＳａＯ２下降者（１６／３０）中，ｍＰＡＰ＞２０ｍｍＨｇ者８例，死亡６例。８８例患者痰中培养出致病菌５７株，死亡者占４３株。结论吸烟、厨房油烟污染、反复呼吸道感染、夜间ＳａＯ２下降，ｍＰＡＰ＞１６ｍｍＨｇ为影响ＣＯＰＤ预后的危险因子。

Objective To investigate the factors which affect the development of COPD. Methods 88 patients with mPAP less than 20 mm Hg were followed up by 5～20 years. Pulmonary ventilation, blood gas analysis, ECG, pulmonary hemodynamic parameters and oxygen saturation at night were performed one time every 5 years. Results The results showed that: 5 year, 10 year and 20 year′s mortality is 6%, 25% and 43% respectively; MVV%, FEV 1% and PaO 2 declined accompanied by the increase of PaCO 2; among 41 patients with mPAP 16～20 mm Hg, 20 patients′ mPAP were more than 20 mm Hg and 15 patients died after 10 years′ follow up. Among 16 patients with the declination of oxygen saturation, 8 patients′ mPAP were more than 20 mm Hg and 6 patients died. 57 strains of infectious bacteria were found in 88 patients′ sputum with 43 strains in the death group. Conclusions These results demonstrated that COPD is a kind of chronic diseases with high death rate; infection, decline of oxygen saturation at night and mPAP more than 16 mm Hg were high risk factors in COPD.