A male, 50 years old. He was admitted to the hospital with “chronic cough, sputum and shortness of breath for more than 3 years, with exacerbation for 2 days. The proposed diagnosis was: secondary pulmonary tuberculosis in both lungs, Tu(-), retreatment Chronic obstructive pulmonary disease Chronic pulmonary heart disease Secondary pulmonary infection Type II respiratory failure Electrolyte disorder The patient developed cough with no obvious cause in January 07, coughing a small amount of white mucous sputum, tight breath, no fever, hemoptysis, chest pain. He was hospitalized in March 2009 with tuberculosis, chronic obstructive pulmonary disease, pulmonary heart disease, and type II respiratory failure, and was discharged in January 2009. He was discharged from the hospital in January 2009 and has been on anti-TB treatment since then. Physical examination: chronic disease, respiratory distress, obvious cyanosis of the lips and extremities, static neck filling, barrel-shaped chest, widened rib space, dry sounds can be heard in both lungs, the left lung can be heard at 114 times/minute, rhythmical, soft abdomen, liver and spleen are not palpable under the ribs, no obvious edema in both lower limbs. Auxiliary examinations: chest CT showed that the upper lungs were patchy and streak-like shadows, the translucency of both lungs was increased, blood gas analysis showed that PH7.35 PaCO266mmHgPO2 35mmHg. blood routine WBC13.8×109/L, NE89%. On the morning of March 8, the blood gas analysis showed that PH7.305 PaCO279.7mmHg PO2 55mHg, and he was transferred to ICU. At the time of transfer, he was clearly conscious, shortness of breath, coughing and sputum, and shortness of breath were obvious. Physical examination: cyanosis of lips, percussion over clear sound in both lungs, strong heart sound, soft abdomen, no edema in both lower limbs. Cardiac monitoring showed: HR 128 beats/min, RR 32 beats/min, BP 135/95 mmHg, SpO 296%. After transfer, cefoperazone sulbactam + azithromycin was given to enhance anti-infection treatment. The patient was actively ventilated with a non-invasive ventilator, and was given symptomatic supportive treatment such as cough and sputum, enteral nutrition, and monitoring of intake and output, etc. The blood gas analysis was repeated at 2:00 p.m.: PH7.218PaCO2106.6mmHgPO2 86mmHg, and the mode of invasive ventilator-assisted ventilation was SIMV+PSV with transoral intubation, which was later changed to PSV. The ventilator parameters and oxygen concentration were gradually adjusted downward. Anti-infection and symptomatic support therapy were continued. The patient became irritable, and was sedated with exemestane, while cardiac arrhythmia was corrected with cortisone. The following day, the patient’s consciousness turned clear and the sedative drugs were stopped. On March 11, sputum smear revealed G+ and G-coccus, and anti-infective treatment was intensified with teicoplanin. Later, the patient’s symptoms and signs gradually improved. On March 15, the patient was extubated and was ventilated with a non-invasive ventilator in sequence, alternating with an oxygen storage mask. on March 26, the patient was clear, without chest distress and tightness. On examination: no dry and wet stalls were detected in both lungs S per dirt fissure or clang nai pox dash dislike S 29, the condition improved significantly, lung infection was controlled, non-invasive ventilator assisted ventilation was used intermittently, liver and kidney function and electrolytes were normal on recheck, and the patient was discharged. Discharge diagnosis: 1, acute exacerbation of chronic obstructive pulmonary disease 2, chronic pulmonary heart disease 3, secondary pulmonary infection 4, II respiratory failure 5, blood electrolyte disorders 6, secondary type of pulmonary tuberculosis in both lungs, coated (-), retreatment