| Chronic obstructive pulmonary disease is a common chronic respiratory disease in clinic,whose typical symptom is chronic cough and sputum, combined with shortness of breath or dyspnea,with or without wheezing,chest tightness.The acute exacerbation of COPD causes the exacerbation of the above symptoms,we need to change the routine medication to maintain the decline in lung function.And each of the acute exacerbation of COPD will lead to a further decline in the patient’s lung function and affect the patient’s labor and quality of life.Due to the decline in the natural respiratory barrier function of COPD patients and the opportunity to use the hormone increase,the risk of impaired immune regulation,making the risk of pneumonia in patients with COPD significantly increased compared to the healthy population.The clinical manifestation is also cough,purulent sputum,shortness of breath or difficulty breathing aggravating,with or without fever,wheezing,etc. it is difficult to identify with AECOPD.But the main pathogenic bacteria and drug resistance characteristics of the two are not the same,and the prognosis is different.If the two confusion,it is easy to appear on the treatment of bias,resulting in delay in the patient’s condition or excessive treatment,resulting in the production of drug-resistant bacteria.Therefore,itis very important to strengthen the understanding of clinical characteristics and points of diagnosis and treatment of two diseases,timely diagnosis and treatment,to improve the quality of life of patients,reduce the mortality rate is particularly important.Objective:To compare and analyze the differences of clinical features and incidence regularity of acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease complicated with community-acquired pneumonia,to strengthen the correct understanding of the two diseases,and to provide a reference for clinical diagnosis and treatment.Methods:Collecting 225 cases of patients with the definite diagnosis for the chronic obstructive pulmonary disease in Department of respiratory medicine in the first hospital of Jilin University Hospital between April2014 to October 2015.They were divided into 2 groups according to medical history and CT scan of the lungs,respectively for the AECOPD group and the COPD combined with CAP group.Compared two groups of patients with general information,clinical symptoms,laboratory tests,complications,treatment,clinical outcomes and stable lung function(transfer of patients within six months of outpatient stable lung function, or the hospital symptoms after complete remission in lungfunction, recording for lung function of stable phase)and other aspects of the difference.Results:1. There was no significant difference in gender between the two groups(P>0.05),the average age of COPD combined with CAP group was slightly higher than that of AECOPD group,but the difference was not statistically significant(P>0.05).2. Comparison of symptoms:compared with AECOPD group,COPD combined with CAP group with worse mental state,fever,cough purulent sputum,chest pain,dyspnea symptoms were more common,the difference was statistically significant(P< 0.05).3. Comparison of pulmonary function in stable stage:compared with the AECOPD group,the ventilation function index FEV1/FVC and FEV1%pred of the COPD combined with CAP group fell more obvious,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups in the peak velocity index(P>0.05).4. Comparison of blood gas analysis:the ratio of hypoxia in COPD combined with CAP group was slightly higher than AECOPD group,but the difference was not statistically significant(P>0.05),while the proportion of carbon dioxide retention in AECOPD group was higher than COPD combined with CAP group,and the difference was statisticallysignificant(P<0.05).5.Comparison of inflammatory indexes and nutritional status:compared with the AECOPD group,the inflammatory index of COPD combined with CAP group increased more significantly,the nutritional status was even worse,the difference was statistically significant(P<0.05).6. Comparison of pathogenic bacteria:pseudomonas aeruginosa infection was the main infection in AECOPD group,Klebsiella pneumoniae infection was the main infection in COPD combined with CAP group,and the latter had a higher proportion of mixed infection,the difference was statistically significant(P<0.05),there was no statistical difference among other pathogenic microorganisms in the other groups(P>0.05).7. Comparison of pulmonary imaging:compared with the AECOPD group, the lesion of multi leaf segment and the proportion of pleural effusion in COPD combined with CAP group were significantly increased,the difference was statistically significant(P<0.05).8. Comparison of complication:the complications of the two groups were more common in respiratory failure,heart failure and electrolyte disorders.Compared with AECOPD group,the complications of COPD combined with CAP group were more,the difference was statistically significant(P<0.05).9.Comparison of treatment:the proportion of the use of antibiotics,the level of antibiotics,the combined ratio of drug use of COPD combined with CAP group were higher than AECOPD group,the difference was statistically significant(P<0.05).10. Comparison of clinical outcomes:compared with the AECOPD group,the length of hospital stay in COPD combined with CAP group was longer,the initial treatment failure ratio,mechanical ventilation ratio,stay in ICU ratio,and 30 days mortality ratio were higher,the difference was statistically significant(P<0.05).Conclusion:1.The symptoms of COPD combined with CAP are similar to that of AECOPD, but the treatment and prognosis of the two are not the same.2.COPD patients with poor nutritional status and poor basic pulmonary function are easy to merge with CAP.3.The correct diagnosis and differentiation of COPD combined with CAP and AECOPD is very important,imaging examination and pulmonary function,ask about the history,observe the clinical symptoms and signs,laboratory examination can be used as a diagnostic method for distinguishing between the COPD combined with CAP and AECOPD. |
