呼吸系统疾病合并意识障碍66例病因分析

发布时间：2018-08-01 16:36

【摘要】：呼吸系统疾病，特别是慢性阻塞性肺病病，易并发肺性脑病引起意识障碍。意识障碍是指人对周围环境以及自身状态的识别和觉察能力出现障碍。一种以兴奋性降低为特点，表现为嗜睡、意识模糊、昏睡直至昏迷；另一种是以兴奋性增高为特点，表现为高级中枢急性活动失调的状态，包括定向力丧失、感觉错乱、躁动不安及言语杂乱等。除呼吸系统疾病外，其它多种系统疾病均可引起意识障碍。基础疾病伴随意识障碍是临床常见的急症和重症之一。随着人口老龄化，基础疾病合并意识障碍的患病率呈上升趋势，意识障碍病情危重，是院前、急诊及病房导致患者死亡的重要原因，早期明确病因是治疗成功的关键。但导致意识障碍的原因多种多样，特别是老年人，常常几种导致意识障碍的病因并存，使意识障碍原因更加复杂化，加之临床表现缺乏特异性，给早期诊断及治疗带来极大困难。目前，各系统疾病基础上出现意识障碍的报道较多，但是，有呼吸系统疾病，目前出现意识障碍，是呼吸系统疾病所致、还是其它系统疾病所致，或者呼吸系统疾病和其它系统疾病并存所致，是呼吸科医生和急诊科医生必须面对的问题，目前这方面的报道甚少，值得临床医生进行研究和探讨。目的：通过临床资料分析呼吸系统疾病合并意识障碍的病因，研究该组病人的临床特点，以期为临床诊治病人提供有益的线索和帮助。资料与方法：本研究收集了2010年1月至2012年1月入住我院，并明确有呼吸系统疾病合并意识障碍的66例患者。其中女性32例，男性34例，年龄最小46岁，年龄最大86岁。回顾性分析其临床资料，判断意识障碍的原因。结果：1、一般资料：66例患者经临床资料综合分析确诊有呼吸系统疾病合并意识障碍，其中女性32例（48.48%），，男性34例（51.52%），年龄46-86岁之间，平均(74.12±9.02)岁，65以上（含65岁）58人（87.88%），占呼吸系统疾病合并意识障碍的主体。2、病因构成：66例患者全部明确病因，其中单一病因62例，占93.9%（62/66），两种病因4例，占6.1%(4/66)，共计70例次呼吸系统疾病合并意识障碍的病因。肺性脑病29例，占41.4%，是呼吸系统疾病患者伴随意识障碍的主要病因。老年性肺炎11例，占15.7%。水电解质代谢紊乱7例，占10.0%。药物不良反应5例，占7.1%。脑梗死4例，占5.7%。肺癌脑转移4例，占5.7%。血糖异常4例，占5.7%，其中，低血糖昏迷3人，高血糖高渗状态1人。高血压脑病2例，占2.9%。心肌梗死1例，肺血栓栓塞症1例，感染性休克1例，上消化道出血1例。4例两种病因导致意识障碍的患者，其中，老年性肺炎合并水电解质代谢紊乱1例，肺性脑病合并水电解质代谢紊乱1例，肺性脑病合并高血压脑病1例，老年性肺炎合并血糖异常1例。3、预后及转归：给予针对病因治疗及对症支持治疗，意识障碍纠正52例，死亡14例，其中单一病因导致意识障碍患者死亡11例，死亡率17.74%（11/62），其中，肺性脑病7例，老年性肺炎1例，上消化道出血1例，肺血栓栓塞症1例，肺癌脑转移1例。两种病因导致意识障碍患者死亡3例，死亡率为75%（3/4），其中，肺性脑病合并水电解质代谢紊乱1例，老年性肺炎合并水电解质代谢紊乱1例，老年性肺炎合并糖尿病高渗性昏迷1例。单一病因组与两种病因组比较，死亡率差异有显著性（P㩳0.05）。结论：1、呼吸系统疾病合并意识障碍的常见原因是肺性脑病、老年性肺炎、水、电解质代谢紊乱、药物不良反应、脑梗死、肺癌脑转移及血糖异常。2、老年人基础疾病多，意识障碍的发病率高，由于这一特殊群体，疾病的临床表现不典型，易造成延误诊治、使病情加重，以致死亡，故应密切观察其病情变化，当有一般状态差时要及时就医，争取在意识障碍前即给予系统诊治。3、掌握利尿剂及相关药物的合理应用原则及指征，强调饮食护理的重要性，避免医源性因素引起意识障碍。4、动脉血气、肺CT、血糖、电解质、脑CT等辅助检查、详细询问病史和系统查体对于明确呼吸系统疾病伴随意识障碍的原因非常重要。5、呼吸系统疾病伴随意识障碍的病因确定，是成功抢救和治疗的关键，临床上不能只局限于呼吸系统疾病所致意识障碍，一定要拓宽思路，寻找其它系统疾病引起的意识障碍是否存在。6、两种病因导致的意识障碍与一种病因者比较，死亡率明显增加。
[Abstract]:Respiratory diseases, especially chronic obstructive pulmonary disease, which are easily associated with pulmonary encephalopathy, cause disturbance of consciousness. Disturbance of consciousness refers to an obstacle to the recognition and awareness of the surrounding environment and self state. One is characterized by reduced excitement, characterized by lethargy, blurred consciousness, lethargy until coma; and the other is increased excitability. It is characterized by a state of acute dysactivity in the advanced center, including loss of orienteering, disorderly sensation, restlessness, and speech disorder. In addition to respiratory diseases, many other systemic diseases can cause consciousness disorders. Basic diseases accompanied by consciousness disorders are one of the most common clinical emergencies and critically ill. The prevalence of disorders of the disease is on the rise, the critical condition of consciousness disorder is the important cause of death in the pre hospital, emergency and ward, and the early clear cause is the key to the success of the treatment. The causes are more complicated, and the lack of specific clinical manifestations brings great difficulties to early diagnosis and treatment. At present, there are many reports of disturbance of consciousness on the basis of various systemic diseases. However, there are respiratory diseases, current disturbance of consciousness, respiratory disease, or other systemic diseases, or respiratory systems. The coexistence of disease and other systemic diseases is a problem that doctors and emergency doctors in the Department of respiration must face. At present, there are few reports in this area. It is worth the research and discussion of the clinicians.
Objective: to analyze the etiology of respiratory diseases with disturbance of consciousness through clinical data, and to study the clinical characteristics of the patients in order to provide useful clues and help for the patients in clinical diagnosis and treatment.
Data and methods: This study collected 66 patients in our hospital from January 2010 to January 2012, and identified 66 cases of respiratory diseases with disturbance of consciousness. 32 of them were female, 34 men were male, the age was 46 years old and the age was 86 years old.
Results: 1, general data: 66 patients were diagnosed with respiratory diseases combined with consciousness disorders, including 32 women (48.48%), 34 males (51.52%), age 46-86 years, average (74.12 + 9.02) years, 65 (65 years of age), accounting for the main body.2 of respiratory diseases with disturbance of consciousness. All 6 patients had a clear cause, including 62 cases of single cause, 93.9% (62/66), two causes 4 cases, 6.1% (4/66), 70 cases of secondary respiratory diseases combined with disturbance of consciousness. 29 cases of pulmonary encephalopathy, accounting for 41.4%, were the main causes of consciousness disorders in patients with respiratory diseases. 11 cases of senile pneumonia, accounting for 15.7%. water electrolyte metabolic turbulence. 7 cases of disorder, accounted for 5 cases of 10.0%. adverse drug reaction, accounting for 4 cases of cerebral infarction in 7.1%., 4 cases of brain metastases in 5.7%. lung cancer, accounting for 4 cases of 5.7%. blood glucose abnormality, accounting for 5.7%. Among them, 3 people with hypoglycemic coma and 1 hyperglycemia, 2 cases of hypertensive encephalopathy, 1 cases of 2.9%. myocardial infarction, 1 thrombus embolism of the lung, 1 cases of septic shock and 1 cases.4 cases two species of upper gastrointestinal bleeding. 1 cases of senile pneumonia complicated with water and electrolyte disturbance, 1 cases of pulmonary encephalopathy combined with water electrolyte disturbance, 1 cases of pulmonary encephalopathy combined with hypertensive encephalopathy, 1 cases of senile pneumonia with abnormal blood glucose.3, prognosis and prognosis: the treatment of etiological treatment and symptomatic support, and 5 of consciousness disorders correction, 5 2 cases, 14 cases of death, of which 11 cases of death were caused by a single cause of consciousness and 17.74% (11/62), of which 7 cases of pulmonary encephalopathy, 1 cases of senile pneumonia, 1 cases of upper gastrointestinal bleeding, 1 cases of pulmonary thromboembolism, 1 cases of lung cancer and 1 cases of brain metastases. Two causes resulted in the mortality of 3, and the mortality was 75% (3/4), of which, pulmonary encephalopathy was merged. There were 1 cases of disturbance of water and electrolyte metabolism, 1 cases of senile pneumonia combined with water electrolyte metabolic disorder, 1 cases of senile pneumonia and hypertonic coma of diabetes mellitus. Compared with two etiological groups, the difference of mortality was significant (P? 0.05).
Conclusions: 1, the common causes of the disturbance of consciousness of the respiratory system are pulmonary encephalopathy, senile pneumonia, water, electrolyte metabolic disorder, adverse drug reaction, cerebral infarction, brain metastasis of lung cancer and abnormal.2 of blood glucose, many basic diseases of the elderly and high incidence of consciousness disorder. After a delay in diagnosis and treatment, so that the condition is aggravated and death, it should be closely observed the change of the disease. When there is a general state of poor medical treatment in time, we should give a systematic treatment to.3 before the disturbance of consciousness, grasp the principle and indication of the rational application of diuretic and related drugs, emphasize the importance of dietary nursing, and avoid iatrogenic factors to cause consciousness disorder. 4, arterial blood gas, lung CT, blood sugar, electrolytes, brain CT and other auxiliary examination, detailed inquiry of the history and systematic examination of the causes of respiratory diseases with the cause of consciousness are very important.5, respiratory disease associated with the cause of consciousness disorder determination, is the key to successful rescue and treatment, clinical can not only be limited to respiratory diseases. The consciousness obstacle must be widened to find out whether there is.6 in the consciousness disorder caused by other systemic diseases. The two causes of consciousness disorder are compared with one of the causes, the mortality rate is obviously increased.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R56;R747.9

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