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Abstract: The patient presented with respiratory symptoms 20 years ago and was diagnosed with chronic obstructive pulmonary disease. He came to the clinic with worsening symptoms and combined respiratory failure 2 months ago. After consultation, the patient was given non-invasive ventilator-assisted therapy, anti-inflammatory cefmetazole sodium for injection and doxorubicin tablets to calm asthma, and nebulized inhalation. After treatment, the patient’s clinical symptoms improved and her general condition was good, and she was discharged successfully.
Basic information】Female, 68 years old
Disease Type】Chronic obstructive pulmonary disease
Hospital】The First Hospital of Harbin Medical University
Date of consultation】May 2022
Treatment plan】Non-invasive ventilator assisted therapy + medication (cefmetazole sodium for injection + doxorubicin tablets + furosemide tablets) + nebulized inhalation (budesonide suspension for inhalation + ipratropium bromide solution for inhalation)
[Treatment period] 10 days of inpatient treatment
Treatment effect】The condition has been controlled and all indicators are improving
I. Initial consultation
The patient, Auntie Li, was diagnosed with chronic obstructive pulmonary disease (COPD) 20 years ago after repeatedly experiencing cough, sputum and dyspnea after activity without obvious causes, and was able to lie down, with a history of waking up at night. The patient had a history of smoking and had been examined several times in the past. The patient had a history of smoking, and previous pulmonary function tests indicated severe obstructive ventilation dysfunction, so the diagnosis of chronic obstructive pulmonary disease was clear.
II. Treatment history
The patient had been diagnosed with chronic obstructive pulmonary disease for more than 20 years. Although he took oral and inhalation asthma medications on a regular basis, he still had significant shortness of breath, and this time, he developed cough and sputum after catching a cold. After admission, he was given pulmonary function, blood gas analysis, routine blood count, cardiac ultrasound, venous ultrasound of both lower extremities, sputum culture, etc. Pulmonary function indicated severe mixed ventilation dysfunction, and blood gas analysis reported elevated partial pressure of carbon dioxide and decreased partial pressure of oxygen. Based on the sputum culture and drug sensitivity results, we applied cefmetazole sodium for injection as anti-infection, doxorubicin tablets as wheezing treatment, non-invasive ventilator to correct hypoxia and carbon dioxide retention, furosemide tablets as diuretic and decongestant, inhalation budesonide suspension and inhalation ipratropium bromide solution as nebulized inhalation to resolve sputum, and advised the patient to pay attention to sputum excretion and monitor body temperature and urine output.
III. Treatment effect
After controlling the infection and correcting the hypoxia, the patient’s blood gas analysis showed that the carbon dioxide retention was significantly improved, the patient’s blood gas analysis showed that the patient had tolerated the prolonged hypoxia, the shortness of breath was significantly improved, the cough was reduced, the sputum volume was significantly reduced, the urine volume increased, and the mental clarity was clear.
IV. Notes
We are glad that the patient’s symptoms have been relieved after treatment.
1. pay attention to the need to quit smoking, avoid contact with polluted environments, prevent colds, receive annual influenza vaccination or pneumococcal vaccination when physical conditions allow, avoid exertion and cold air inhalation, and regularly monitor lung function.
2. Patients should pay attention to rest after returning home, avoid straining, regularly apply inhaled bronchodilators, prevent osteoporosis, enhance physical fitness, strengthen nutrition and maintain an optimistic state of mind.
3, patients should have long-term home oxygen therapy, such as acute respiratory failure, vital signs are not stable need to promptly call the emergency number, go to the hospital for treatment.
V. Personal insight
In this case, the patient has a history of smoking for many years, and the chronic obstructive pulmonary disease has continued for many years and has been aggravated recently, so the patient should be given corresponding examination and treatment to make the patient improve gradually. Chronic obstructive pulmonary disease is a common chronic airway disease that can be prevented and treated. Its occurrence and development are related to chronic inflammation of airways and lungs to harmful particles or harmful gases, and its symptoms mostly occur in autumn and winter cold seasons, often with a history of recurrent respiratory infections and acute exacerbations. Hypoxemia and hypercapnia appear in the late stage of chronic obstructive pulmonary disease, which can be complicated by chronic pulmonary heart disease and pulmonary encephalopathy. Patients present with high cough and sputum volume, and dyspnea is aggravated compared with usual days, which requires active anti-infection, sputum and symptomatic treatment, keeping the airway unobstructed, correcting lack of oxygen, regular inhalation of bronchodilators, and avoiding the decline of lung function.