患者男性,78岁,主因咳嗽、气喘20余年,加重伴嗜睡1d入院。查体:T37.7℃,R32次/min,BP13.3/9.3kPa。神志恍惚,桶状胸,叩诊过清音,双肺满布干湿性罗音,无心衰体征。心电图示肺性P波,重度顺钟问转位。血气报告:pH7.417,PCO_26.9kPa,PO_25.4kPa。入院诊断:慢性肺原性心脏病、Ⅲ型呼吸衰竭。入院后经抗感染、平喘解痉治疗后,病情缓解,入院半月后,病人出现嗜睡,肝功能、尿素氮化验结果正常,连续3d血气报告:pH7.599～7.661,HCO_3~-50.5～54.4mmol/L,PaCO_26.0～7.6kPa,PaO_25.7 Male patient, 78 years old, mainly due to cough, asthma more than 20 years, aggravated with lethargy 1d admission. Physical examination: T37.7 ℃, R32 times / min, BP13.3 / 9.3kPa. Conscious trance, barrel chest, percussion voiceless, lungs covered with wet and dry rales, no signs of heart failure. ECG Pulmonary P wave, severe cis asked translocation. Blood gas report: pH7.417, PCO_26.9kPa, PO_25.4kPa. Admission diagnosis: Chronic pulmonary heart disease, type Ⅲ respiratory failure. After admission, anti-infective and anti-asthmatic antispasmodic therapy was used to relieve the symptoms. After half a month’s hospitalization, the patient developed lethargy and liver function. The results of urea nitrogen test were normal. Blood gas was reported for three consecutive days from pH 7.59 to 7.661 and from HCO 3 to -50.5 to 54.4 mmol / L, PaCO_26.0 ~ 7.6kPa, PaO_25.7