摘要
目的总结慢性阻塞性肺疾病急性发作期（AECOPD）合并左心衰竭诊治体会。方法选取我院2009年10月~2013年12月住院AECOPD患者100例,其中单纯AECOPD组60例,合并左心衰竭组40例,完善血常规、电解质、血气分析、N-末端B型脑钠肽（Nt-pro BNP）及超声心动图等检查,给予吸氧、抗感染、化痰平喘、抗心衰和无创正压通气治疗等治疗,对比分析两组患者的临床资料。结果合并左心衰竭组患有高血压、冠心病等基础疾病35例（87.5%）,均有不同程度的呼吸困难和肺部湿啰音,Nt-pro BNP平均（4525.3±565.7）ng/L,超声检查左室扩大30例（75%）,合并呼吸衰竭20例（50%）,平均住院时间（22.1±6.5）d,死亡7例（17.5%）,上述指标与单纯AECOPD组比较,差异有统计学意义。结论慢性阻塞性肺疾病急性发作期合并左心衰竭发生率高,多发于基础疾病较多的患者,易合并呼吸衰竭,预后较差。Nt-pro BNP和超声心动图检查是诊断左心衰竭的重要指标,有效控制感染,合理应用利尿剂和应用无创正压通气有助于提高治疗效果。
Objective To summarize the diagnosis and treatment rules for acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicated by left heart failure. Methods One hundred patients with AECOPD hospitalized in our hospital from October 2009 to December 2013 were selected and divided into two groups, of which the simple AECOPD group consisted of 60 patients and the associated left heart failure group consisted of 40 patients. Examinations including blood routine examination, electrolyte, blood gas analysis, N-terminal B-type natnuretic peptide（Ntpro BNP） and ultrasonic cardiogram were completed and treatment including oxygen uptake, antibiotics, phlegm reduction and asthma relieving, anti-heart failure and noninvasive positive pressure ventilation therapy were given. Clinical data of the two groups of patients were analyzed and compared. Results In the associated left heart failure group, 35 patients（87.5%） suffered from underlying diseases such as hypertension and coronary heart disease and all suffered from varying degrees of dyspnea and lung moist rale; The average value of Nt-pro BNP was（4525.3±565.7） ng/L; 30 patients（75%） had left ventricular enlargement under ultrasonic examination; 20 patients（50%） were complicated by respiratory failure; The average hospital stay was（22.1±6.5） days and 7 patients died（17.5%）. The above indicators were statistically different from those of the simple AECOPD group. Conclusion The acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicated by left heart failure has a high incidence, is prone to happen in patients with underlying diseases, is prone to be complicated by respiratory failure, and has poor prognosis. Nt-pro BNP and ultrasound cardiogram examinations are important diagnosis indicators of left heart failure. Effective control of infection and rational application of diuretic and non-invasive positive pressure ventilation are conducive to improving the treatment effects.
出处
《中国现代医生》
2015年第7期17-19,共3页
China Modern Doctor
关键词
慢性阻塞性肺疾病急性发作期
左心衰竭
诊断
Acute exacerbation of chronic obstructive pulmonary disease with
Left heart failure
Diagnosis
