肺部感染和酸碱失衡程度对慢性阻塞性肺病伴急性下呼吸道感染合并呼吸衰竭疗效、血气指标及预后的影响

Effect of pulmonary infection and acid-base imbalance on curative effect,blood gas indexes and prognosis of chronic obstructive pulmonary disease complicated with acute lower respiratory infection and respiratory failure

目的探讨肺部感染和酸碱失衡程度对慢性阻塞性肺疾病(COPD)伴急性下呼吸道感染合并呼吸衰竭(RF)患者疗效、血气指标及预后的影响。方法选取2020年6月至2021年6月在南昌市第三医院进行治疗的70例COPD伴急性下呼吸道感染合并RF患者作为研究对象,所有患者均予以常规治疗并随访1年。依据肺部感染评分(CPIS)分为轻度组(CPIS≤6分)40例与重度组(CPIS>6分)30例。随后根据酸碱失衡预计代偿公式分成单纯酸碱失衡组25例、二重酸碱失衡24例及三重酸碱失衡组21例,比较不同亚组间治疗疗效、血气指标及随访期间的生存率。结果经常规治疗后,重度组的总有效率低于轻度组,三重酸碱失衡组的总有效率低于单纯酸碱失衡组;重度组的氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))水平及生存率均低于轻度组,二氧化碳分压(PaCO_(2))高于轻度组;三重酸碱失衡组的PaO_(2)、SaO_(2)水平及生存率低于单纯酸碱失衡组、二重酸碱失衡组,PaCO_(2)高于单纯酸碱失衡组、二重酸碱失衡组,差异有统计学意义(P<0.05)。结论COPD伴急性下呼吸道感染合并RF患者肺部感染与酸碱失衡程度越严重者治疗效果越低,治疗后血气指标越差,预后越不佳。

Objective To investigate the effect of pulmonary infection and acid-base imbalance on curative effect,blood gas indexes and prognosis of chronic obstructive pulmonary disease(COPD)complicated with acute lower respiratory infection and respiratory failure(RF).Methods A total of 70 patients with COPD complicated with acute lower respiratory infection and RF who were treated in the Third Hospital of Nanchang City from June 2020 to June 2021 were selected as the research subjects.All patients were given routine treatment and followed up for one year.According to the clinical pulmonary infection score(CPIS),the subjects were divided into mild group(CPIS≤6,40 cases)and severe group(CPIS>6,30 cases).According to the predicted compensation formula of acid-base imbalance,the subjects were divided into simple acid-base imbalance group(25 cases),double acid-base imbalance group(24 cases)and triple acid-base imbalance group(21 cases).The curative effect,blood gas indexes and survival rate during follow-up were compared among the subgroups.Results After routine treatment,the total response rate in severe group was lower than that in mild group,the total response rate in triple acid-base imbalance group was lower than that in simple acid-base imbalance group,the partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))and survival rate in severe group were lower than those in mild group,while partial pressure of carbon dioxide(PaCO_(2))was higher than that in mild group,the PaO_(2),SaO_(2)and survival rate in triple acid-base imbalance group were lower than those in simple acid-base imbalance group and double acid-base imbalance group,while PaCO_(2)was higher than those in the simple acid-base imbalance group and double acid-base imbalance group,the differences were statistically significant(P<0.05).Conclusion For patients with COPD complicated with acute lower respiratory infection and RF,the more severe the pulmonary infection and acid-base imbalance,the worse the curative effect,blood gas indexes and prognosis.