高海拔地区慢性肺心病急性加重期极重度呼吸衰竭并发多器官功能衰竭的救治体会

摘要

目的 探讨高海拔地区慢性肺心病急性加重期(HAAECCP)极重度呼吸衰竭并发多器官功能衰竭(MOF)的救治.方法 62例(男37例,女25例,平均年龄59.5岁)HAAECCP极重度呼吸衰竭(PaO2<30 mmHg)并发MOF患者,采用了抗感染、通畅气道、利尿、强心、吸入29～35%氧、呼吸兴奋剂、糖皮质激素、降低血粘度等方法救治.结果 2个、3个、4个、5个及5个以上器官衰竭(OF)者分别为43例、10例、5例和4例,救治成功率分别为100.0%、90.0%、60.0%和0.0%.总救治成功率88.7%,病死率11.3%.结论 HAAECCP极重度呼吸衰竭并发MOF患者救治24 h后,若PaO2能提高到40 mmHg以上,则基本可救治成功,若仍低于30 mmHg,则应尽早行机械通气.%Objective To assess the emergency treatment of extremely severe respiratory failure in chronic cor pulmonale with a-cute exacerbation ( HAAECCP ) and associated multiple organ failure ( MOF ) at high altitude. Methods 62 patients ( 37 males, 25 females, average age of 59. 5 ) with extremely severe respiratory failure ( PaO2 <30 mmHg) in HAAECCP and associated MOF were treated. The treatments included anti-infectives, diuretics, cardiac tonics, respiratory stimulants, glucocorticoids, inhalation of 29% ~35% oxygan, airway-clearing and decreasing the blood viscosity. Results Of the 43 cases, 10 cases,5 cases and 4 cases with 2, 3, 4, 5 or more organ failures, the rate of success were 100. 0% , 90. 0% , 60. 0% and 0. 0% respectively. The overall rate of success and mortality were 88. 7% and 11.3%. Conclusion Despite of the existence of extremely severe respiratory failure and MOF in patients with HAAECCP, the emergency treatment were mostly successful if PaO2 could be increased to more than 40 mmHg within 24 hours of treatment start. However, should PaO2 remained to be lower than 30 mmHg, then mechanical ventilation should be employed as early as possible.