合并慢性呼吸衰竭COPD患者不同精神状态的血气分析

Relationship between blood gase analysis and mental status of patients with chronic obstructive pulmonary disease in chronic respiratory failure

目的探讨合并慢性呼吸衰竭(CRF)COPD患者不同精神状态的动脉血气状况。方法回顾性分析70例合并CRF的COPD病例精神状态及其血气资料。结果纳入分析的70例临床病例中80%合并慢性Ⅱ型呼吸衰竭,清醒至兴奋(AE)组PaCO2为(53.24±12.12)mmHg、动脉血pH为(7.42±0.05),嗜睡至模糊(SV)组PaCO2达(63.87±13.34)mmHg、动脉血pH为(7.36±0.08),昏睡至昏迷(CS)组PaCO2高达(90.96±22.16)mmHg、动脉血PH低达(7.20±0.10),三组之间PaCO2、动脉血pH值的差异显著。CS组氧合指数仅为(209.53±51.83),明显低于AE组的(332.96±121.93)和SV组的(270.58±122.96)。SV组TCO2高达(39.00±9.25)mmol/L,显著高于AE组的(33.53±6.06)mmol/L;CS组病人TCO2为(38.53±9.37)mmol/L,与其他两组间的差异不显著。三组之间PaO2、HCO3-、BE的差异不显著。结论合并CRF的COPD病人精神状态可以反映其PaCO2和pH值,病人精神状态越差PaCO2越高、动脉血pH值越低。

Objective To inquire into the relationship between blood gase analysis and mental status of patients with chronic obstructive pulmonary disease in chronic respiratory failure.Methods Retrospective analysis was conducted on of 70 cases including blood gas analysis and their mental status.Results 80% were complicated with type Ⅱ respiratory failure who,were divided into three groups.The average values of PaCO2 and pH were respectively（53.24±12.12） mmHg and（7.42±0.05） in the awake in the excited group,（63.87±13.34） mmHg and（7.36±0.08） in the somnolent in the vague group,（90.96±22.16） mmHg and（7.20±0.10） in the comatose in the stuporous group,The group differences were significant.The oxygenation index was only（209.53±51.83） in the comatose to stuporous group,obviously lower than that of（332.96±121.93） in the awake in the excited group and（270.58±122.96） in the somnolent in the vague group.The value of TCO2 reached（39.00±9.25） mmol/L in the somnolent in the vague group,which was significantly higher than that of（33.53±6.06） mmol/L in the awake in the excited group.However,There was practically no difference in the values of TCO2（averaged 38.53±9.37 mmol/L） in the comatose in the stuporous group and two other guoups.But little difference was observed in blood gas parameters-PaO2,HCO3 and BE among the three groups.Conclusion The conditions of dysphrenia of patients with chronic obstructive pulmonary disease in chronic respiratory failure can reflect the different levels of PaCO2 and the values of pH.The worse the mental status,the higher the value of PaO2,and the lower the pH.