引起AECOPD精神神经异常的原因及治疗对策

目的：探讨引起慢性阻塞性肺疾病合并精神神经异常的原因,以制订有针对性的治疗对策。方法：回顾性分析我院自2010年1月到2013年1月期间收治的250例慢性阻塞性肺疾病急性发作期患者的临床资料。结果：32例患者出现精神神经异常症状,占12.80%。其中17例为肺性脑病,占53.13%（17/32）,8例为低渗性脑病,占25.00%（8/32）,5例为药物的不良反应,占15.63%（5/32）,2例为脑梗死,占6.25%（2/32）。所有患者均给予慢性阻塞性肺疾病急性发作的常规治疗方案进行治疗,同时肺性脑病患者给予积极纠正二氧化碳潴留;低渗性脑病患者给予积极纠正电解质紊乱;脑梗死的患者根据情况给予溶栓、脱水、营养脑神经、抗凝、抗血小板聚集等治疗;药物不良反应的患者则给予停止应用相应的药物。经过治疗后,29例症状恢复,占90.63%,3例最终死亡,死亡率为9.38%,其中2例为肺性脑病患者,1例为低渗性脑病患者。结论：对于慢性阻塞性肺疾病急性发作合并精神神经异常的治疗,应根据患者的症状、体征以及辅助检查结果,尽早明确诊断,及时干预,尽快控制病情,防止病情恶化。

The Reason and Treatment of Abnormal Mental Nerve of Patients with Chronic Obstructive Pulmonary Disease

Objective： To investigate the reason of abnormal mental nerve of patients with chronic obstructive pulmonary disease, and to formulate the strategy of treatment. Methods： The clinical data of 250 patients with acute exacerbation of chronic obstructive pulmonary disease was analyzed retrospectively in our hospital. Results： 32 patients appeared nervous and mental symptoms, accounted for 12.80%. Including 17 cases of pulmonary encephalopathy, accounted for 53.13%（17/32）, 8 cases of hypotonic encephalopathy, accounted for 25%（8/32）, 5 cases of adverse drug reactions, accounted for 15.63%（5/32）, 2 patients with cerebral infarction, accounted for 6.25%（2/32）. All patients were given conventional treatment of acute exacerbations of chronic obstructive pulmonary disease, at the same time, the measurement of positive correction of carbon dioxide retention was given to the patients of pulmonary encephalopathy; the encephalopathy were given positive correction of electrolyte imbalance and low permeability; the cerebral infarction patients were given treatment of thrombolytic, dehydration, brain nutrition, anticoagulation, antiplatelet therapy according to the condition of patients with adverse drug. After treatment, 29 cases symptom recovery, accounting for 90.63%, 3 cases died, the mortality was 9.38%, including 2 cases of pulmonary encephalopathy patients, 1 case of hypotonic encephalopathy. Conclusion： In the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with abnormal mental, it should be according to the patient＇s symptoms, signs and auxiliary examination results, early diagnosis, to give timely intervention, control the illness as soon as possible, and to prevent deterioration.