<原著>慢性閉塞性肺疾患 (COPD) 急性増悪に関する臨床的研究

Abstract

Two hundred and thirty consecutive episodes of acute excerbations in COPD pts. admitted to OCH in 2 years (July 1980-June 1982) were clinically studied concerning diagnosis, treatment, and outcome. These 230 episodes were seen in 126 pts. (males 76, average age, 71.4 yrs and females 50, average age 74.8 yrs) and were classified as bronchitic type, 68 cases (52.4%), emphysematous 18 (14.3%), and DPB (Diffuse Panbronchiolitis) 4 (3.2%). They were managed according to the diagnostic, therapeutic, and rehabilitational protocols mainly made by the author. Admission episodes were most frequent in February even in subtropical climate of Okinawa. The most frequent contributory factor for acute exacerbation in COPD was lower respiratory infection (in 85.2%) and was followed by pneumothorax, asthmatic fits and so on. The management of acute respiratory failure in COPD varied according to clinical status and the values of arterial blood gas analysis and accordingly nasal-prong oxygenation, maskoxygenation, T-piece system or mechanical ventilation were utilized. The indication for intubation in this situation is still internationally controversial but the author had his own criteria based on his clinical experiences. The reason for intubation was most commonly seen in the condition of hypercarbia with respiratory acidosis complicated by consciousness disturbances (68.1%) and the aterial blood gas analysis done just prior to intubation showed average PaCo2 of 72.2mmHg. If the prolonged mechanical ventilation (longer than 2 weeks) was anticipated clinically, tracheostomy was done as early as 1 week after intubation. 110 episodes in 51 cases required mechanical ventilation repeatedly in 2 years and 80 episodes (72.3%) were successfully salvaged.