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目的 探讨老年慢性阻塞性肺疾病 (COPD)急性加重的发生 ,发展及治疗。方法 2 0 0 3年 9月到2 0 0 4年 2月 ,我院 6 5岁以上的老年 COPD急性加重的住院患者。结果 10 0例中合并慢性肺源性心脏病 5 9例、冠心病 17例、原发性高血压 4 1例、合并高血压性心脏病 12例、糖尿病 14例、老年瓣膜性心脏病 7例 ;发生心衰 5 2例、呼吸衰竭 37例、肾功能不全 2 3例、肝功能不全 8例、心律失常 7例 ;其中合并 1种其他脏器病变的患者 2 4例 ,合并 2种其他脏器病变的患者 33例 ,合并 3种及 3种以上其他脏器病变的患者 37例 ;死亡 8例。合并 1种其他脏器病变 (1例 ) 12 .5 % ,合并 2种其他脏器的病变 (2例 ) 2 5 % ,合并 3种及 3种以上其他脏器的病变 (5例 ) 6 2 .5 % ;死亡组与非死亡组患者入院时的血白细胞 ,动脉血气等实验室指标比较 ,统计测定显著性差异。结论 老年呼吸道防御功能下降招致的呼吸道反复感染 ,可能是老年人 COPD发病率增加的原因 ;老年 COPD病患者多合并呼吸 ,心脏和其他脏器的病变 ;急性加重患者的处理 ,应在积极抗感染的同时注意其他脏器合并症和功能衰竭的治疗。
Objective To investigate the occurrence, development and treatment of acute exacerbation of senile chronic obstructive pulmonary disease (COPD). Methods From September 2003 to February 2004, hospitalized patients aged 65 years and older with acute exacerbation of COPD in our hospital. Results Of the 10 cases, 59 were complicated with chronic cor pulmonale, 17 with coronary heart disease, 41 with essential hypertension, 12 with hypertensive heart disease, 14 with diabetes, 7 with valvular heart disease 52 cases of heart failure, 37 cases of respiratory failure, 23 cases of renal insufficiency, 8 cases of hepatic insufficiency and 7 cases of cardiac arrhythmia. Among them, 24 cases were complicated with one kind of other organ diseases and 2 kinds of other dirty Thirty-three patients with lesions and 37 patients with three or more lesions of other organs were included. There were 8 deaths. 12.5% of patients with one other organ disease (1 case), 2 cases (2 cases) with 2 other types of organ disease, 5 cases (3 cases) and 3 cases of other organ diseases (5 cases) 6 2 .5%; Compared with laboratory indexes such as blood leucocyte, arterial blood gas and the like in the death group and the non-death group on admission, the statistical difference was statistically significant. Conclusions The respiratory tract infection caused by the decline of airway defense function in elderly may be the reason of the increased incidence of COPD in the elderly. The elderly patients with COPD often have the pathological changes of respiratory, cardiac and other organs. The patients with acute exacerbation should be actively infected At the same time pay attention to the treatment of other organ complications and failure.