慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭并发上消化道出血的诱发因素分析

Predisposing factors analysis of chronic obstructive pulmonary disease with type Ⅱ respiratory failure complicated by upper gastrointestinal bleeding

目的探讨慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭并发上消化道出血的诱发因素,分析总结其临床特征。方法选择2008年2月至2011年10月收治的43例COPD合并Ⅱ型呼吸衰竭并发上消化道出血患者作为观察组,另同期随机选择40例未并发上消化道出血的COPD合并Ⅱ型呼吸衰竭患者作为对照组。观察比较两组患者血气分析结果及诱发因素,分析其并发上消化道出血的原因。结果观察组pH值和动脉血氧分压明显低于对照组,动脉血二氧化碳分压明显高于对照组,差异均有统计学意义(P<0.05);观察组因肝肾功能损害、重症感染、全身激素使用而发生上消化道出血的发生率均高于对照组,差异均有统计学意义(P<0.05)。结论 COPD合并Ⅱ型呼吸衰竭并发上消化道出血与低氧血症、高碳酸血症、重症感染及应用损害胃肠黏膜药物等因素有密切关系,且以低氧血症、高碳酸血症为主要因素,需尽早干预。

Objective To investigate the predisposing factors of chronic obstructive pulmonary disease （COPD） with type Ⅱ respiratory failure complicated by upper gastrointestinal bleeding,and to analyze and summarize the clinical features. Methods 43 cases of COPD with type Ⅱ respiratory failure complicated by upper gastrointestinal bleeding hospitalized from February 2008 to October 2011 were selected as observation group,40 cases of COPD with type Ⅱ respiratory failure without up- per gastrointestinal bleeding were randomly selected as control group. Blood-gas analysis and predisposing factors in the two groups were observed to analyze the cause of concurrent upper gastrointestinal bleeding. Results PH value and PaO2 in blood- gas analysis in observation group was obviously lower than those in control group, but the PaCO2 was significantly higher than that in control group with statistically significant difference （P〈0.05）. The occurrence rate of damage of hepatorenal function, serious infection and upper gastrointestinal bleeding after adopting hormone in the whole body in the observation group was all higher than that in the control group with statistically significant difference （P〈0.05）. Conclusion COPD with respiratory failure complicated by upper gastrointestinal bleeding has relative relationship with hypoxemia, hypercapnia, serious infection and application of drugs damage to gastrointestinal mucosa, and the hyooxemia and hvDercaDnia are in main. so the early intervention is needed.