Objective To investigate the clinical characteristics of acute myocardial infarction ( AMI) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed. Meanwhile, 128 elderly AECOPD patients without AMI were analyzed as control. Results Neither the AMI group nor the control group had typical precordial pain, conscious disturbance, andhypotension. Compared with the control group, the main symptoms of the AMI group were worsening of chest tightness and dyspnea( 16 /16 vs. 4/128, P lt;0. 01) ,most of which accompanying fever( 11/16 vs. 6/128, P lt;0. 05) and anorexia ( 10/16 vs. 23 /128, P lt; 0. 05) . The incidence of patches-like shadow on chest X-rayincreased ( 16 /16 vs. 62/128, P lt;0. 05) , PaO2 ( mm Hg) decreased ( 43. 72 ±3. 64 vs. 82. 26 ±11. 41, P lt;0. 001) , the red blood cell count ( ×1012 /L) increased ( 6. 43 ±0. 42 vs. 4. 11 ±1. 24, P lt; 0. 05) , the concentration of total cholesterol ( mmol /L) increased ( 6. 51 ±0. 84 vs. 3. 93 ±1. 14, P lt; 0. 05) , the needfor invasive mechanical ventilation increased ( 13/16 vs. 11 /128, P lt; 0. 05) , the days in hospital were prolonged ( 35 ±13 vs. 11 ±3, P lt; 0. 01) , the cost ( 1000 RMB) increased( 32 ±11 vs. 7. 6 ±2. 8, P lt;0. 01) , and the mortality also increased ( 2/16 vs. 3 /128, P lt;0. 01) . Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.
【Abstract】 Objective To analyze the risk factors for ventilator-associated pneumonia ( VAP) in respiratory intensive care unit ( RICU) , as well as the impact on mortality. Methods A retrospective cohort study was conducted in 105 patients who had received mechanical ventilation in RICUbetweenMay 2008 andJanuary 2010. The duration of intubation, vital signs, primary disease of respiratory failure and complications,blood biochemistry, blood routine tests, arterial blood gas analysis, APACHEⅡ score,medications, nutritional status, bronchoalveolar lavage ( BAL) , protected specimen brush ( PSB) quantitative culture, chest X-rayexamination were recorded and analyzed. Results The incidence rate of VAP was 32. 4% . Mortality in the VAP patients were significantly higher than those without VAP( 58. 8% vs. 28. 2% , P = 0. 007) . The duration of intubation, hypotension induced by intubation, cerebrovascular disease, and hypoalbuminemiawererisk factors for VAP in RICU. Conclusions Mortality of the patients with VAP increased obviously. The risk factors for VAP in RICU were the duration of intubation, hypotension after intubation, cerebrovascular disease, and hypoalbuminemia.