How to treat senile cor pulmonale?

Elderly cor pulmonale, also known as elderly chronic pulmonary heart disease, is a kind of heart disease with or without right heart failure, which is caused by chronic lesions of lung tissue, pulmonary artery vessels or chest cavity, resulting in increased pulmonary vascular resistance and pulmonary artery pressure. This paper introduces the knowledge of etiology, symptoms, treatment, nursing and prevention of pulmonary heart disease in the elderly. Introduction of pulmonary heart disease in the elderly Chronic pulmonary heart disease (referred to as "chronic pulmonary heart disease" for short) refers to the heart disease in which chronic lesions of bronchus, lung, thorax or pulmonary artery cause increased pulmonary circulation resistance and pulmonary hypertension, leading to right ventricular hypertrophy and right heart failure. It can be caused by chronic bronchitis, emphysema, bronchial asthma, bronchiectasis, tuberculosis, pneumoconiosis, congenital pulmonary cyst's disease, pulmonary fibrosis, chest malformation, etc. Chronic bronchitis and obstructive emphysema are the most common, and primary pulmonary vascular diseases are rare. Its incidence in China is about 0.46%, which is common in the elderly.

Etiology of senile cor pulmonale (1) Chronic bronchial and pulmonary diseases are the most common. Chronic obstructive pulmonary disease is the main cause of cor pulmonale in China. Others, such as bronchial asthma, severe tuberculosis, bronchiectasis, pneumoconiosis, interstitial lung disease, etc. It can also be secondary to the late stage of chronic cor pulmonale.

(2) Severe kyphosis, spinal tuberculosis, thoracoplasty, severe pleural hypertrophy and other serious chest malformations.

(3) Pulmonary vascular diseases, such as pulmonary embolism and idiopathic pulmonary hypertension.

(4) Other neuromuscular diseases, such as poliomyelitis, muscular dystrophy, obesity with insufficient pulmonary ventilation, sleep and breathing disorders, etc.

Symptoms of senile cor pulmonale The disease is a long-term and chronic process, and signs of organ damage such as lung and heart failure gradually appear. According to the compensation period and decompensation period of its function.

(1) compensatory period of lung and heart function (including remission period)

The main clinical manifestation of this period is chronic obstructive emphysema. It is characterized by cough, expectoration, wheezing, palpitation after exercise, shortness of breath, fatigue and decreased labor endurance. Physical examination showed obvious signs of emphysema. Due to the increase of pressure in pleural cavity, vena cava reflux is blocked, jugular vein is filled, barrel chest, respiratory movement is reduced, voice tremor is reduced, respiratory sound is reduced, exhalation is prolonged, wheezing sound and wet sound are heard at the bottom of lung, the voiced boundary of heart is reduced, telecentric sound is reduced, the voiced boundary of liver is reduced, and the liver has tenderness, positive hepatic jugular vein reflux, edema and peritoneal effusion. And common edema of lower limbs in the afternoon. The second heart sound may be hyperactivity of pulmonary valve area, suggesting pulmonary hypertension. Systolic murmur in tricuspid valve area or subxiphoid heartbeat suggest right ventricular hypertrophy. Diaphragm descent makes the upper and lower boundaries of the liver move down obviously, which should be differentiated from liver congestion syndrome of right heart failure.

(2) decompensated period of pulmonary and cardiac functions (including acute exacerbation period)

The main clinical manifestation of this period is respiratory failure or heart failure.

Respiratory failure: The common inducement is acute respiratory infection, mostly respiratory failure with ventilation disorder (type II respiratory failure), and hypoxemia and hypercapnia coexist. Hypoxemia is characterized by chest tightness, palpitation, shortness of breath, headache, fatigue and abdominal distension. When the arterial oxygen saturation is lower than 90%, there will be obvious cyanosis. People with severe hypoxia experience restlessness, coma or convulsions. Sedatives or hypnotics should not be used at this time to avoid aggravating carbon dioxide retention and pulmonary encephalopathy. Hypercarbonation is characterized by skin wetness and sweating, superficial vein dilatation, red pulse, conjunctival congestion and edema, pupil contraction, even exophthalmos, hand tremor, dizziness, headache, lethargy and coma. This is the result of vasodilation and capillary permeability increase caused by carbon dioxide retention. When severe respiratory failure is accompanied by mental and neurological disorders, excluding other causes is called pulmonary encephalopathy.

Heart failure: Pulmonary heart disease only has signs of pulmonary hypertension and right ventricular hypertrophy in the functional compensation period, and there is no heart failure. Right heart failure, palpitation, shortness of breath, jugular vein dilatation, hepatomegaly, edema of both lower limbs, and even systemic edema and ascites occur in decompensated period, and a few patients may be accompanied by left heart failure or arrhythmia.

Complications of senile cor pulmonale Common complications of cor pulmonale include upper gastrointestinal bleeding, renal insufficiency, pulmonary encephalopathy, DIC, etc.

Analysis of arterial blood gas in the treatment of senile cor pulmonale (1)

Hypoxemia or hypercapnia may occur in pulmonary function compensation period of cor pulmonale. When pao 2

(2) Blood examination

In patients with hypoxic pulmonary heart disease, red blood cells and hemoglobin can increase, and the hematocrit is as high as 50%. When complicated with infection, the total number of white blood cells increased, neutrophils increased, and the nucleus moved to the left. Serological examination can have changes in renal function or liver function, as well as changes in high potassium, low sodium, low chlorine, low calcium and low magnesium.

(3) Others

Pulmonary function examination is of great significance for early or remission stage of cor pulmonale. Bacteriological examination of sputum can guide the selection of antibacterial drugs in acute exacerbation of cor pulmonale.

(4)X-ray examination

In addition to the characteristics of lung and chest diseases and acute lung infection, pulmonary hypertension can also be found: ① the right lower pulmonary trunk is dilated, and its transverse diameter is ≥15 mm; The ratio of transverse diameter to transverse diameter of trachea is ≥ 1.07. ② Pulmonary artery segment protruding or height ≥ 3 mm..③ ③ The dilated central pulmonary artery is in sharp contrast with the slender peripheral branches. ④ The optic cone is obviously prominent (the right anterior oblique position is 45) or the "cone height" is ≥ 7 mm..⑤ ⑤ Right ventricular hypertrophy sign. The above five criteria, with 1, can diagnose cor pulmonale.

(5) ECG examination

It is the change of right atrium and ventricle hypertrophy, such as the right deviation of electric axis, the average electric axis of frontal plane ≥+90, severe clockwise transposition (V5: r/s ≤ 1), RV1+sv5 ≥1.05mv. aVR shows QR type and pulmonary type P wave. Right bundle branch block and low voltage pattern can also be seen, which can be used as reference conditions for the diagnosis of cor pulmonale. At V 1, V2 even extends to V3, and QS waves similar to old myocardial infarction patterns appear.

(6) vectorcardiogram examination

It is characterized by hypertrophy of right atrium and right ventricle. With the aggravation of right ventricular hypertrophy, QRS orientation gradually evolved from the normal left anterior lower or back to the right, then down, and finally turned to the right anterior, but the terminal part was still in the right posterior. QRS ring develops from counterclockwise operation or "8" shape to clockwise operation in severe cases. The P-ring is narrower, the amplitude of the left frontal P-ring increases, and the maximum vector is forward, down, left or right. The more obvious the right atrial hypertrophy is, the more right the P-ring vector is.

(7) Echocardiographic examination

Right ventricular outflow tract diameter (≥30mm), right ventricular diameter (≥20mm), right ventricular anterior wall thickness (≥5mm) and the ratio of left and right ventricular diameters (

Diagnosis of senile cor pulmonale

According to the medical history, clinical manifestations and related examinations, pulmonary hypertension or right ventricular hypertrophy are confirmed, and decompensation is mainly respiratory failure and right heart failure, so clinical diagnosis can be made.

differential diagnosis

Pulmonary heart disease with left ventricular hypertrophy is not uncommon. Pulmonary heart disease can also cause abnormal myocardial repolarization and ischemic ST-T ECG changes, especially in the elderly. Left ventricular damage can be caused by the increase of left ventricular load caused by hematocrit, hyperviscosity, hypervolemia, bronchopulmonary vascular shunt and repeated toxemia-hypoxemia-peripheral vascular contraction in heart failure, or by the coexistence of coronary heart disease and hypertensive heart disease, which can be distinguished according to the above points.

1, cor pulmonale often coexists with coronary heart disease, which makes the condition and symptoms more atypical. Patients with cor pulmonale have one of the following conditions. Those with left ventricular hypertrophy can be diagnosed as cor pulmonale complicated with coronary heart disease:

2. Typical angina pectoris occurs in the remission stage of cor pulmonale, and the ECG changes are myocardial ischemia;

3. Chest tightness or precordial pain, as well as ECG changes of acute myocardial infarction, GOT and LDH increased significantly;

4. ECG has old myocardial infarction changes, and it can be ruled out that the lung and heart resemble myocardial infarction patterns;

5, ⅲ degree atrioventricular block or complete left bundle branch block can be ruled out;

6. Coronary angiography showed that coronary atherosclerosis met the diagnostic criteria of coronary heart disease;

7. The senile cor pulmonale complicated with pulmonary encephalopathy should be differentiated from senile dementia, cerebrovascular disease, hypertensive encephalopathy, hepatic encephalopathy, diabetic coma and toxic encephalopathy.

How to treat senile pulmonary heart disease should not only treat the basic diseases of lung and chest, improve the functions of lung and heart, but also maintain the functions of various organs and take measures to treat them. Control infection, dredge respiratory tract, improve respiratory function, correct hypoxia and carbon dioxide retention, and correct respiratory and heart failure.

(1) Actively control pulmonary infection.

Pulmonary infection is a common cause of acute exacerbation of cor pulmonale, and only by controlling pulmonary infection can the condition be improved. Sputum culture and drug sensitivity test were done before antibiotics were used to find out the infected pathogens as the basis for choosing antibiotics. Before the results come out, antibiotics should be selected according to the infection environment and gram staining of sputum smear. Gram-positive bacteria account for the majority of nosocomial infections, while gram-negative bacteria account for the main part of nosocomial infections. Or both antibiotics. Attention must be paid to possible secondary fungal infections when choosing broad-spectrum antibiotics. After the culture results come out, select targeted antibiotics according to the types of pathogenic microorganisms. The course of treatment is 10 ~ 14 days, but it mainly depends on the patient's condition.

(2) The respiratory tract is unobstructed

In order to improve the ventilation function, we should clear the oropharyngeal secretions, prevent the stomach contents from flowing back to the trachea, change positions frequently, and encourage coughing hard to facilitate expectoration. Those who are too weak to expectorate after a long illness should pat the patient's back with their hands to help expectorate. If the ventilation is seriously insufficient, the mind is not clear, the cough reflex is slow, the sputum is excessive and sticky, and the respiratory tract is blocked, an artificial airway should be established and sputum should be sucked regularly. Humidify respiratory tract and sputum. Mucolytic agents and expectorants can be used. At the same time, use drugs to dilate bronchi and improve ventilation.

Bronchodilator: ① selective β2 receptor agonist; ② Theophylline drugs.

Eliminating airway nonspecific inflammation: Prednisone is commonly used and beclomethasone is inhaled. The dose of corticosteroids varies from person to person and should not be too large to avoid adverse consequences.

(3) correct hypoxia and carbon dioxide retention

Oxygen therapy: For oxygen therapy without carbon dioxide retention (type I respiratory failure), large flow oxygen inhalation (> 35%) should be given to increase the PaO2 _ 2 _ 2 to 8kPa(60mmHg) or SaO2 _ 2 _ 2 to more than 90%. The time to absorb high concentration oxygen should not be too long to avoid oxygen poisoning. Oxygen therapy for hypoxia with carbon dioxide retention (type ⅱ respiratory failure) should be given low-flow continuous oxygen inhalation. Oxygen therapy can adopt double-lumen nasal catheter, nasal catheter or mask, and take oxygen at the oxygen flow rate of 1 ~ 2l/min.

Breathing stimulant: Breathing stimulant includes Nikethamide, Lobelin, Doxapram, Duxil, etc. Patients with drowsiness can be slowly injected intravenously first. Closely observe the changes of patients' eyelash reaction, conscious state, respiratory rate and arterial blood gas in order to adjust the dose.

Mechanical ventilation: Patients with severe respiratory failure should be given mechanical ventilation as soon as possible.

(4) Correct acid-base imbalance and electrolyte disorder.

The acute exacerbation of cor pulmonale is prone to acid-base imbalance and electrolyte disorder, and respiratory acidosis, respiratory acidosis combined with metabolic acidosis or metabolic alkalosis are common. The treatment of respiratory acidosis lies in improving ventilation. When respiratory acidosis is combined with metabolic acidosis, pH is obviously decreased, and when pH

(5) reducing pulmonary artery pressure

Oxygen therapy is one of the measures to treat pulmonary hypertension. Targeted drug therapy of pulmonary hypertension should depend on the type of pulmonary hypertension.

(6) control heart failure

The treatment of heart failure of cor pulmonale is different from other heart diseases, because heart failure can be improved after patients with cor pulmonale actively control infection and improve respiratory function. However, for patients with ineffective or severe treatment, diuretics and positive inotropic drugs can be appropriately selected.

Diuretics: eliminate edema, reduce blood volume and reduce right heart load. The application principle is the application of a small number of burst services.

Positive inotropic drugs: correct hypoxia, prevent hypokalemia and avoid toxic reaction of digitalis before medication. The application indications are as follows: ① Repeated edema after infection in patients with heart failure has been controlled, hypoxemia has been corrected, and diuretics cannot achieve good curative effect; ② Right heart failure is the main manifestation of patients without obvious infection; ③ Patients with acute left heart failure; ④ Patients with supraventricular tachycardia, such as supraventricular tachycardia, atrial fibrillation with rapid ventricular rate.

(7) Brain edema

Pulmonary heart disease is often complicated with pulmonary encephalopathy due to severe hypoxemia and hypercapnia. Clinically, it has neuropsychiatric symptoms, intracranial hypertension and brain edema. We should reduce intracranial pressure as soon as possible, relieve brain edema and control its neuropsychiatric symptoms. ① Take 20% mannitol as dehydrating agent, and give it by rapid intravenous drip, 1 ~ 2 times a day. Pay close attention to the changes of blood electrolytes during medication. ② Corticosteroids must be used in combination with effective antibiotics and drugs to protect gastric mucosa, such as bismuth potassium citrate (Dele) and compound bismuth aluminate (Weibizhi), so as not to aggravate respiratory infection and induce upper gastrointestinal bleeding. Dexamethasone, aminophylline and nikethamide were administered intravenously in 5% glucose solution. According to the severity of the disease, give 1 ~ 3 doses every day. After the symptoms of pulmonary encephalopathy are relieved and the brain edema is relieved, the drug can be reduced.

(8) Strengthen nursing care

Closely observe the changes of the disease and strengthen the monitoring of cardiopulmonary function. It is an effective measure to improve ventilation function to turn over and pat the back to eliminate respiratory secretions.

The prognosis of senile cor pulmonale varies with the primary disease, which is closely related to the cardiopulmonary function in remission and whether it is actively and correctly treated and managed in remission. With the development of medical technology, the mortality rate is decreasing year by year. Patients with decompensated pulmonary heart disease without serious complications are still in good condition after active and reasonable rescue treatment; Patients with lung, brain, gastrointestinal bleeding, DIC and multiple organ failure have poor prognosis.

Can senile cor pulmonale be cured? Suffering from senile cor pulmonale must not be delayed and should be treated in time. The mild initial cure is relatively simple, and it is more troublesome to treat it before it develops to a serious degree. Choose a specialized hospital for treatment, treat under the guidance of a doctor, and pay attention to drinking more water, avoid eating too much greasy food, avoid spicy and irritating food, and ban alcohol. Diet conditioning in life is very important, and the need for good living habits is the key to disease rehabilitation.

Nursing care of elderly patients with cor pulmonale (1)

Don't abuse antibiotics, and stop using antibiotics when your condition improves and stabilizes. Antibiotics should not be taken for a long time to avoid drug resistance or infection by other bacteria.

(2) Diet care

Generally speaking, the first thing a nurse should think about is how to arrange the patient's diet. According to experience, the ideal diet for patients is a vegetarian diet, eat more fruits and liver containing vitamin C and vitamin E, and eat some lean meat and eggs in moderation, but not too much, so as not to increase the burden on the kidneys.

(3) keep exercising.

Patients should do some appropriate activities according to their personal conditions to improve their disease resistance. Take a walk in the morning, play Tai Ji Chuan and do deep breathing exercises. It can enhance physical fitness and exercise cardiopulmonary function, but we should pay attention to what we can do during exercise to avoid overwork and prevent patients from participating in activities that increase cardiopulmonary function load.

(4) Enhance immunity

Because cor pulmonale is easy to aggravate in cold season, winter is the "death gate" for patients with cor pulmonale. Therefore, it is important to prevent and increase the ability to keep out the cold, first of all, to carry out cold training. The method is: since spring, after rubbing red hands every day, rub the head, face and limbs for 10 minute, and rub the exposed parts of the whole body several times a day, all year round; Wash your nose with cold water every day since summer; Wash your face with cold water from autumn to winter. Strengthen warmth, wear hats, scarves, masks and thick shoes and socks when going out in winter. Keep the indoor temperature, don't catch cold at night, and so on. If proper measures are taken, patients can spend the winter safely.

(5) Psychological nursing

Emotional changes will aggravate the condition. The elderly have poor self-reliance and have been ill for many years, so they are easy to feel inferior. When their families are not properly taken care of for a period of time, they often feel more disappointed and even lose confidence in treatment. Therefore, it is necessary to do a good job of psychological counseling for patients and guide them to treat themselves correctly and understand others. In addition, according to personal hobbies, you can participate in some recreational activities, such as listening to music and playing chess. Keep a good mood and an optimistic mental state. Establishing confidence in overcoming diseases is conducive to the transformation of diseases into health.

Prevention of senile cor pulmonale (1) Primary prevention

Also known as etiological prevention. Mainly by preventing diseases such as bronchus, lung and pulmonary vessels that can cause this disease, we can achieve the purpose of disease-free prevention, improve people's health knowledge, enhance disease resistance and actively prevent the inducing factors of the primary disease. Such as respiratory infection, inhalation of allergens, harmful gases, dust and so on. Through publicity and education, advocating smoking cessation, applying effective smoking cessation drugs and labor protection, the purpose of etiology prevention was achieved.

(2) Secondary prevention

Early diagnosis and treatment of cor pulmonale can prevent the further development of cor pulmonale and restore the damaged cardiopulmonary function as much as possible through clinical means. Take effective physical examination methods with strong pertinence to find cor pulmonale whose lung and heart functions are still in the compensatory stage in time, and monitor the structure and functional state of organs such as lung and heart to prevent the occurrence of cor pulmonale emergencies.

(3) tertiary prevention

For patients who have been diagnosed with pulmonary heart disease, take active and appropriate treatment and rehabilitation measures to minimize the damage of pulmonary heart disease to the body, protect the residual functions of lung and heart, and give full play to them, and attach importance to the treatment of complications.

The diet of senile cor pulmonale (1) is suitable: it is advisable to eat food to prevent heart disease; It is advisable to eat foods that enhance immunity; It is wise to eat foods that lower cholesterol.

(2) dietary taboos: avoid eating foods with high cholesterol; Such as egg yolk, crab, animal viscera; Avoid eating foods that stimulate sympathetic nerves; Such as strong tea and coffee; Avoid salty food, such as salted eggs, bacon, salted chicken, salted duck and salted fish.

(3) dietotherapy

Appropriate amount of frost radish is decocted instead of tea. Radish has the functions of reducing qi, relieving cough and resolving phlegm, and is suitable for patients with pulmonary heart disease with excessive phlegm.

Appropriate amount of ginger juice, almond 15g, walnut kernel 30g, mashed with appropriate amount of honey and stewed. This recipe has the effects of warming the middle warmer, resolving phlegm, tonifying kidney and absorbing qi. This prescription is suitable for patients with lung and kidney qi deficiency.

Porphyra 15g, oyster 50g, polygala tenuifolia 15g. Decoct with water. This prescription has the functions of eliminating phlegm, clearing away heat and calming the nerves. Suitable for patients with severe cough at night.

3-6 grams of ginseng and 5 walnuts. Add appropriate amount of water and decoct. This recipe has the effects of invigorating spleen and qi, tonifying lung and kidney. Used for people with cough but shortness of breath, spontaneous sweating, fatigue and eating less.

Perilla frutescens 12g, japonica rice 100g, and a little rock sugar. First, wash perilla, mash it, put it in a pot with japonica rice and rock sugar, add appropriate amount of water, boil it with strong fire first, and then cook it into porridge with slow fire, and take it twice a day in the morning and evening. This recipe has the effects of invigorating spleen, moistening dryness, resolving phlegm and relieving cough. It is suitable for people with cough and excessive phlegm, chest distress and anorexia.

Eriobotrya leaf porridge: Eriobotrya leaf 10 ~ 15g, japonica rice 100g, and appropriate amount of rock sugar. Wrap loquat leaves in a casserole with gauze, add 200ml of water, fry to 100ml, remove residue and add 600ml of water to cook porridge, and take it warm every morning and evening.

Lily almond porridge: fresh lily 50g, almond 10g, japonica rice 50g. Cook the rice first, then add lily and almond, and add sugar to make porridge twice a day.

Precautions for senile cor pulmonale (1) When a cold comes, you should add clothes in time, don't catch cold, don't let yourself feel cold, and pay more attention to wearing warm clothes when going out. Because once caught cold, bronchial mucosal blood vessels contract, and the immune function of patients with cor pulmonale is low, it is easy to cause viral and bacterial infections. Generally, the upper respiratory tract first, and then spread to the lower respiratory tract, causing pneumonia or bronchopneumonia. In addition, for patients with cor pulmonale, keeping feet warm is also very important and can not be ignored.

(2) Take part in some outdoor activities. When the weather is fine, you can go for a walk in parks, forests and other places with fresh air in the morning, do some exercises within your power, such as Tai Ji Chuan, Qigong, abdominal breathing, and exercise the diaphragm function, so you should persevere. When sweating, dry it with a dry towel and change your underwear in time. The results show that long-term exercise can improve people's immune function and lung function. The amount of exercise is based on the premise of not causing shortness of breath or other discomfort. Avoid going to places with dirty air.

(3) Keep indoor air circulation. You should open the window in the morning to get some fresh air. Burning charcoal fire or coal fire in the bedroom, especially without exhaust pipe, is not good for patients with cor pulmonale and should be avoided as much as possible.

(4) Life should be regular. What time do you get up, sleep, eat, defecate and go out for a walk every day? It's best to take a nap at noon, feel comfortable, and the family should live in harmony. Patients with cor pulmonale are inevitably angry because of long-term suffering from the disease, so try to restrain yourself and not lose your temper.

(5) Smokers should give up smoking completely, and don't even talk, play chess or cards with smokers, because passive smoking is equally harmful to patients with cor pulmonale. Expectoration in time to keep the respiratory tract clean.

(6) supplement nutrition. Patients with cor pulmonale often have nutritional disorders, and there are more emaciated people, but they often have poor appetite. In principle, you should eat less and eat more meals, and you can also take some drugs to strengthen your stomach or help digestion. It is not advisable to eat too salty food.

(7) The manifestations of senile cor pulmonale complicated with lower respiratory tract infection are often atypical. Symptoms such as fever and cough may not be obvious, and sometimes they are only manifested as shortness of breath, increased sputum volume or thickened sputum. All these should go to the hospital in time, don't delay.

(8) Don't abuse cardiotonic agents, diuretics and propranolol by yourself. Improper medication will aggravate the condition and even cause accidents.

(9) Family oxygen therapy can be carried out if conditions permit, which is beneficial to improve hypoxia, improve the quality of life and prolong life.

(10) In order to improve the immune function of the elderly, BCG injection can be injected intramuscularly, once 1ml, twice a week for ***3 months. This can reduce the occurrence of colds and upper respiratory tract infections.