摘要:目的: 探讨重度、极重度COPD急性加重期合并多MODS临床特征和预后有关的危险因素。 方法 :回顾分析1999～2009年因重度、极重度COPD急性期合并多器官功能障碍而住院的患者临床资料。 结果 :本研究共纳入226例患者,平均年龄为693±52岁。呼吸系统功能障碍发生率最高,有200例。其次是心血管功能障碍和中枢神经功能障碍,各102例。患者的病死率随着器官功能障碍的数目增加而增加。 结论 :治疗重度、极重度COPD急性加重时,在常规治疗基础的同时防治MODS是降低患者病死率的关键。Abstract: Objective: To analyze the clinical characters and risk factors that relevant to prognosis of severe or very severe chronic obstructive pulmonary disease(COPD)exacerbation combining with multiple organ dysfunction syndrome(MODS). Methods :The clinical data of patients who was admitted to hospital for exacerbation of severe or very severe COPD combing with MODS ｉｎ 1999 to 2009 were retrospective analyzed. Results : 226 cases were analyzed in this study, the mean age of patients was 693±52 The incidence of respiratory system dysfunction was highest, which was 200 cases, and followed by the incidence of cardiovascular dysfunction and central nervous system dysfunction, which was 102 respectively. The mortality of these patients increased with the increasing number of organ dysfunction. Conclusion : Pｒｅｖｅｎｔ ａｎｄ te at MODS on the basis of conventional treatment of severe or very severe COPD exacerbation is the key factor that could reduce mortality of these patients.
Objective To summarize and explore the clinical features, diagnosis and treatment of severe pulmonary tuberculosis (TB). Methods One death case of pulmonary TB in The First Affiliated Hospital of Soochow University was analyzed, related publications of case reports and articles relevant on the analysis and study of pulmonary tuberculosis deaths from Pubmed between January 2012 and March 2022 were also reviewed. Results A 25-year-old female patient was admitted for "intermittent cough with sputum for more than 1 year, aggravated with chest tightness and shortness of breath for 5 days". She had no underlying disease. Pulmonary TB was diagnosed by TB bacterium smear and next-generation sequencing of bronchoalveolar lavage fluid. The patient was in shock compensation period and developed acute respiratory distress syndrome immediately after admission. Through active anti-tuberculosis, invasive mechanical ventilation, intra-aortic balloon counterpulsation and continuous renal replacement therapy, the disease continued to deteriorate and she died on the third day after admission. A total of 269 pulmonary TB deaths were retrieved. An analysis of 244 patients' past medical history showed that human immunodeficiency virus co-infection was the most common among young people and chronic diseases were the most common among the elderly. All 269 patients died of septic shock, respiratory failure and multiple organ dysfunction syndrome (MODS), among which hyponatremia was also a significant complication. The shortest time from admission to death was 7 days, while the longest average time was only 35 days. Conclusions Pulmonary TB could develop into septic shock and MODS with poor prognosis and high mortality. Health education on TB should be strengthened.