老年慢性阻塞性肺疾病合并呼吸衰竭 危险因素分析

Risk factors of chronic obstructive pulmonary disease complicated with respiratory failure in elderly patients

摘要:

目的 探讨老年慢性阻塞性肺疾病（COPD）合并呼吸衰竭的临床流行病学特点、临床症状、生 理生化改变，分析引起老年COPD 合并呼吸衰竭的原因。方法 选取2016 年1 月-2017 年1 月天津医院196 例老年COPD 合并呼吸衰竭患者作为病例组，同期选取202 例单纯老年COPD 患者作为对照组，回顾性分析 两组患者在住院期间基本临床资料、临床症状和肺功能检测，以及生化检查指标，找出差异进一步进行Logistic 回归分析。结果 病例组患者平均年龄、体重指数、吸烟史等临床资料与对照组比较，差异无统计学意义（P >0.05）； 而病例组的颈围与对照组比较，差异有统计学意义（P <0.05），病例组高于对照组；病例组在合并心血管疾病、 肾脏疾病、患病时间与对照组比较，差异有统计学意义（P <0.05），病例组高于对照组。咳嗽、咳痰这两个临床 常见症状在两组中差异无统计学意义（P >0.05）；病例组呼吸困难、COPD 合并低蛋白血症、夜间憋醒者与对 照组比较，差异有统计学意义（P <0.05），病例组患者例数高于对照组。病例组的FEV1% 预计值与对照组比较， 差异有统计学意义（P <0.05），病例组低于对照组；Logistic 回归分析，发现呼吸困难、夜间憋醒、低蛋白血症、 心血管病史、肾脏疾病史及病程时间与老年COPD 合并呼吸衰竭和颈围均有相关（P <0.05）。结论 对于临床 上表现有呼吸困难、夜间憋醒、低蛋白血症并且合并心血管病史、肾脏疾病史、长病程的老年COPD 患者 应提高警惕，因为此类患者合并呼吸衰竭的可能性极高。

Abstract:

Objective To investigate the clinical epidemiological characteristics and clinical symptoms, physiological and biochemical changes of chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods Totally 196 elderly patients with COPD and respiratory failure in Tianjin Hospital from January 2016 to January 2017 were selected as the case group, and 202 cases of elderly patients with only COPD but no respiratory failure during the same period were collected as the control group. The clinical data, clinical symptoms, pulmonary function tests and biochemical indexes of the two groups of patients in the hospital were retrospectively analyzed. Logistic regression analysis was applied to figure out the causes of respiratory failure in the patients with COPD. Results There was no significant difference in the average age, body mass index or smoking history between the two groups (P > 0.05). The neck circumference of the case group was longer than that of the control group, the difference was statistically significant (P < 0.05). The incidences of complicated cardiovascular diseases and kidney diseases were higher and the time of illness was longer in the case group than in the control group, there were significant differences (P < 0.05). No significant difference was found in cough or sputum between the two groups (P > 0.05). The incidences of dyspnea, COPD complicated with hypoproteinemia, and night arousal in the case group were significantly higher than those in the control group (P < 0.05). The FEV1% predictive value in the case group was much lower than that in the control group, the difference was statistically significant (P < 0.05). Logistic regression analysis revealed that dyspnea, night arousal, hypoproteinemia, history of cardiovascular diseases, kidney disease history, and disease duration were correlated with elderly COPD with respiratory failure and neck circumference (P < 0.05). Conclusions Attention should be paid to the elderly patients with COPD who have the clinical manifestations of dyspnea, nocturnal awakenings, hypoproteinemia and who are combined with cardiovascular disease history, kidney disease history, and long disease duration. The possibility of respiratory failure is greatly increased in such patients.