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The correlation between infection and prothrombogenesis has not been assessed in acute exacerbation of chronic obstructive pulmonary disease (COPD) in elderly person. We have evaluated AT-Ⅲ: Ag and fibronectin (Fn) in 35 patients (age 72±8 years) with clinical evidence of exacerbation (PaO_2 7.4±1.1kPa). AT-Ⅲ: Ag was found decreased (<22.96 mg%) in 21 patients, and Fn decreasd (<185μg/ml) in 10 patients. AT-Ⅲ:Ag was decreased in all patients (n=10) in whom Fn was decreased. The values... The correlation between infection and prothrombogenesis has not been assessed in acute exacerbation of chronic obstructive pulmonary disease (COPD) in elderly person. We have evaluated AT-Ⅲ: Ag and fibronectin (Fn) in 35 patients (age 72±8 years) with clinical evidence of exacerbation (PaO_2 7.4±1.1kPa). AT-Ⅲ: Ag was found decreased (<22.96 mg%) in 21 patients, and Fn decreasd (<185μg/ml) in 10 patients. AT-Ⅲ:Ag was decreased in all patients (n=10) in whom Fn was decreased. The values of AT-Ⅲ:Ag were 22.23±4.87mg% and 12.45±2.86 mg% respectively in patients with normal level and decreased level of Fn (P<0.01). There was a significant correlation between the values of AT-Ⅲ:Ag and Fn (r 0.61 P<0.01). It is thus concluded that during acute exacerbation of COPD in elderly persons, inflammation, hypoxemia, and hypercapnia provoke the development of prethrombogenesis state which induces the vicoous circle, and AT-Ⅲ:Ag is the objective indicator for early detection of widespread prethrombogenesis state. 本文对35例慢性阻塞性肺疾病(COPD)急性加重期AT-Ⅲ:Ag和FN的关系作出评价。21例AT-Ⅲ:Ag降低(<22.96mg%)。10例FN降低(<185μg/ml),FN降低者其AT-Ⅲ:Ag值均降低。FN降低者和正常者其AT-Ⅲ:Ag分别为12.45±2.86mg%和22.23±4.87mg%(P<0.01)。AT-Ⅲ:Ag和FN值间有一定相互关系(r=0.61 P<0.01)。认为在老年COPD急性加重期,炎症、低氧血症和高碳酸血症促使血栓前状态发生和发展,并形成恶性循环;AT-Ⅲ:Ag可作为早期预测血栓前状态的客观指标。 The C-reactive protein (CRP) and haptoglobin(Hp) measurements in 26 patients (age 75±8) with acute exacerbation of chronic obstructive pulmonary disease (COPD) in elderly patients were evaluated. These patients had serial measurements of CRP, Hp, ESR Fg, the absolute numbers and differential counts of the peripheral white cell, analysis of blood acid-base and gas contents, body temperature, and chest X-ray, in addition to serial sputum bacteriological studies. CRP was elevated in all patient... The C-reactive protein (CRP) and haptoglobin(Hp) measurements in 26 patients (age 75±8) with acute exacerbation of chronic obstructive pulmonary disease (COPD) in elderly patients were evaluated. These patients had serial measurements of CRP, Hp, ESR Fg, the absolute numbers and differential counts of the peripheral white cell, analysis of blood acid-base and gas contents, body temperature, and chest X-ray, in addition to serial sputum bacteriological studies. CRP was elevated in all patient (n=26). white cell count was lowered with therapy, showing a positive correlation with the CRP level (r=0.60, P<0.01). Hp was increased in 24 patients. ESR was quickened in 16 patients, the percentage of increased Hp was significantly higher than that of quickened ESR in all Patient (X~26.93, P<0.01). Hp was increased in all patients in whom ESR was quickened, exhibiting a positive correlation with the elevated ESR level (r=0.54, P<0.05). It was concluded that in the assessment of acute exacerbation of COPD in elderly patients, the measurment of serum CRP may provide an early, reliable, and sensitive objective indicator of infection, and the measurement of serum Hp may provide an stable, and sensitive indicator of active infection. 文章对26例老年COPD急性加重期的C-反应蛋白(C-reactive protein,CRP)和触珠蛋白(haptoglobin,Hp)测定作出评价(年龄75±8岁)。除了痰细菌培养外,都作了CRP、Hp、ESR、Fg、周围白细胞计数和分类、血气分析、体温和胸片检查。26例CRP全部升高,(25.58±15.37μg/ml),经治疗后CRP下降(5.34±2.96pg/ml)(P<0.01),且与白细胞下降之问有一定相互关系(r=0.60,P<0.01)。24例Hp增高(>372mg/dl),16例ESR增高(>12mm/h)。Hp增高例数明显多于ESR增高例数(x~2=6.93 P<0.01)。ESR增高者Hp全部增高,二者增高值间有一定相互关系(r=0.54,P<0.05)。老年COPD急性加重时,CRP是敏感和可靠的早期客观炎症指标。Hp是稳定和敏感的活动性炎症指标。 Objective To summarize the results of patients of severe respiratory failure using multiple times mechnical ventilation (MV) via tracheal intubation (or via tracheotomy). Methods We retrospectively analysed clinical information and follow up results of 15 acute exacerbation of COPD patients using MV more than 3 times. Results MV was used 77 times in 15 patients. The highest number of MV was 20. 86% were weaned successfully. The mean duration of MV via intubation was 13 days and via tracheotomy was... Objective To summarize the results of patients of severe respiratory failure using multiple times mechnical ventilation (MV) via tracheal intubation (or via tracheotomy). Methods We retrospectively analysed clinical information and follow up results of 15 acute exacerbation of COPD patients using MV more than 3 times. Results MV was used 77 times in 15 patients. The highest number of MV was 20. 86% were weaned successfully. The mean duration of MV via intubation was 13 days and via tracheotomy was 37 days, mean 649 days via the latest brocheotomy after using MV multiple times. The survival duration after the first MV varied from 196 to 4 420 days in 15 patients, mean 1 093 days, medium survival duration of the patients was 1 673 days, survival rates after 1,2,3 and 5 years were 73%, 64%, 33% and 25% respectively. The causes of death were failure of multiple organs or disfunction of other vital organs. Conclusions Repeated application of MV may prolong the survival rates of COPD with severe respiratory failure. It′s important to take strictly the indication of MV, correctly to select the methods of artifical airway, combining invasive and noninvasive ventilation, properly to apply the strategies of MV. 目的总结对慢性阻塞性肺疾病(COPD)合并严重呼吸衰竭患者反复多次气管插管(或切开)进行机械通气的经验。方法回顾性分析因COPD急性加重而机械通气3次以上的15例患者的临床资料及随访结果。结果15例患者共机械通气77例次,其中1例最多通气20次。脱机拔管成功率86%,其中气管插管机械通气者平均通气时间13天,气管切开通气者平均37天。多次通气最后气管切开者平均通气649天。15例患者首次机械通气后的生存时间196~4420天,平均1093天。中位生存期为1673天。1、2、3、5年生存率分别为73%、64%、33%和25%。死因是多脏器衰竭(MOF)或其他脏器严重功能紊乱。结论对晚期COPD合并严重呼吸衰竭患者实施反复多次的机械通气可延长生存期。重要的是要严格掌握适应证,正确选择人工气道的方法,有创和无创性通气相结合以及恰当应用机械通气的策略。
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