正常甲状腺病态综合征对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者机械通气的影响

The impact of euthyroid sick syndrome on mechanical ventilation in patients who suffered from acute exacerbations of chronic obstructive pulmonary disease with type Ⅱ respiratory failure

目的本文旨在探讨正常甲状腺病态综合征对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者机械通气的影响。方法选择2013年在我院呼吸科住院的101例慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者,依据甲状腺功能分为对照组58例与正常甲状腺病态综合征组43例。收集入选者基本情况、疗效、机械通气、气管插管情况等资料,分析两组机械通气率、气管插管率及好转率的差异。结果甲状腺功能正常组(对照组)与正常甲状腺病态综合征组的好转率分别为100.0%和90.7%,机械通气的使用率分别为25.7%和62.8%,气管插管率分别为5.2%和27.9%,两组比较差异有统计学意义(P<0.05),入院时动脉血气分析中甲状腺功能正常组与正常甲状腺病态综合征组PaCO_2分别为(62.8±18.6)mmHg、(74.7±21.2)mmHg,pH值分别为(7.358±0.096)、(7.294±0.100),两组比较差异有统计学意义(P<0.05)。结论合并正常甲状腺病态综合征的慢性阻塞性肺病急性加重伴Ⅱ型呼吸衰竭患者气管插管及机械通气率发生率高,提示甲状腺功能检测有助于病情严重程度评估。

Objective To discuss the impact of euthyroid sick syndrome on mechanical ventilation in patients who suf- fered from acute exacerbations of chronic obstructive pulmonary disease with type Ⅱ respiratory failure. Methods A total of 101 patients who were admitted to respiratory department for acute exacerbation of chronic obstructive pulmonary disease with type II respiratory failure in 2013 were enrolled in this study. The patients were divided into normal thy- roid function group （58 cases） and euthyroid sick syndrome gourp （43 cases） according to thyrbid function. The basic situation of patients, efficacy, mechanical ventilation, intubation were collected. Mechanical ventilation usage rates, intubation rates and the rate of improvement were analyzed. Results Between normal thyroid function group and euthyroid sick syndrome group,the improvement rates were 100.0% and 90.7%, the utilization of mechanical ventilation were 25.7% and 62.8%, the intubation rates were 5.2% and 27.9%, respectively. The differences of two groups were significant（P〈 0.05）. Arterial blood gas analysis on admission were carried out in the two groups. Compared with the control group, euthyroid sick syndrome group had significantly higher PaCO2 （74.7±21.2 mmHg vs 62.8±18.6 mmHg, P〈0.05）, and lower pH values（7.294±0.100 vs 7.358±0.096,P〈0.05）. Conclusion Patients combined with euthyroid sick syndrome who were suffering from acute exacerbations of chronic obstructive pulmonary disease with type Ⅱ respiratory failure has higher intubation rates and mechanical ventilation rates, suggesting that thyroid function tests mays help to assess the severity.