高龄慢性阻塞性肺疾病的临床特点分析

目的：了解高龄慢性阻塞性肺疾病（COPD）患者的临床和实验室检查特点。方法：收集2012 年1 月至2013 年7 月我院收治的80 岁以上COPD 患者（高龄组）和80 岁以下COPD 患者（非高龄组）各50 例的临床资料，比较两组的临床特征、合并症、实验室检查和临床治疗结果。结果：①与非高龄组比较，高龄组既往慢性支气管炎病史和平均住院天数均显著延长，因急性发作的入院率、死亡率和平均住院总费用均显著增高，喘息、呼吸困难和下肢浮肿的发生率均显著增高（P〈0.05）。②高龄组患者合并基础疾病者更多，以高血压、心功能不全、冠心病、心律失常和脑血管病后遗症为主，两组比较有显著性差异（P〈0.05）。③高龄组C 反应蛋白、B型尿钠肽前体、肌红蛋白和高敏肌钙蛋白均显著升高，总蛋白、白蛋白和血红蛋白水平显著降低（P〈0.05）。④高龄组胸腔积液和左心室舒张功能显著降低的发生率显著升高（P〈0.05），但两组咳嗽、咳痰、发热及合并呼吸衰竭、糖尿病和肿瘤的发生率无显著性差异（P〉0.05）；且两组白细胞总数，中性粒细胞百分比、降钙素原、肌酸磷酸激酶、血气分析包括PH 值、氧分压、二氧化碳分压和氧饱和度比较无显著性差异（P〉0.05）；两组肺部炎症、肺气肿、肺大泡、陈旧性肺结核、左心室收缩功能降低的发生率和心电图检查比较无显著性差异（P〉0.05）。⑤两组治疗方法和治疗结果亦无显著差异（P〉0.05）。结论：高龄COPD 患者急性发作临床症状不典型，白细胞总数和中性粒细胞升高亦不显著，需要重视出现的喘息，呼吸困难和下肢浮肿症状。患者症状隐匿，常因病情突然加重而急诊入院；高龄COPD患者合并症多，基础疾病与COPD急性加重症状易重叠，导致病情复杂、危重使治疗费用和住院时间明显延长。高龄COPD 患者更易合并心血管疾病，贫血和低蛋白血症是其预后不良的敏感指标。

Clinical Analysis of COPD in Elderly Patients

Objective： To understand the clinical characteristics and laboratory features of elderly inpatient with chronic obstruc- tive pulmonary disease （COPD）. Methods： From Jan 2012 to July2013, 50 older than 80 years （Elderly group） and 50 less than 80 years （Non-elderly group） COPD inpatients data were collected, the clinical features, comorbidities, laboratory tests and clinical treatment were compared between two groups. Results： （L） Elderly group showed longer chronic bronchitis history and duration of hospital stay, higher incidence of admission due to acute exacerbation of COPD （AECOPD）, higher mortality, higher total cost of hospitalization and higher incidence of symptoms of wheezing, dyspnea and lower limbs edema（P〈0.05）. （~） Elderly group showed higher comorbidity incidence of underlying disease which mainly included hypertension, heart failure, coronary heart disease, arrhythmia and cerebrovascular disease se- quelae （P〈0.05）. （~） Elderly group had significantly increased C-reactive protein, pro B-type natriuretic peptide, myoglobin and high-sen- sitivity troponin, and also had significantly decreased total protein, albumin and hemoglobin （P〈0.05）. （~） Elderly group had higher inci- dence of pleural effusion and decreased left ventricular diastolic function （P〈0.05）, however, symptoms of cough, sputum, fever, inci- dence of respiratory failure, diabetes and cancer showed no difference （P〉0.05）. Meanwhile, Tests of leukocytes, neutrophil percentage, procalcitonin, creatine kinase and blood gas analysis including pH, PO2, PCO2 and oxygen saturation didn＇t show any difference （P〉 0.05）. Tests of pulmonary inflammation, emphysema, bullae, old tuberculosis, decreased left ventricular systolic function and ECG results showed no difference （P〉0.05）. Treatment methods and results also showed no difference （P〉0.05）. Conclusion： Elderly COPD patients represent atypical clinical symptoms and may not have significant leukocytes and neutrophils increase. Clinical emerging symptoms of wheezing, dyspnea and lower extremity need to be emphasized. Elderly patients with hidden symptoms could be acute admission due to acute exacerbation of symptoms. Elderly COPD patients represent more comorbidities, underlying disease and AECOPD symptoms easily overlap, leading to more complex critical condition, higher treatment costs and longer duration of hospital stay. Elderly patients have higher incidence of cormorbidity of cardiovascular disease. Anemia and hypoalbuminemia are sensitive indicators of poor prognosis.