The thesis is dedicated to increasing the efficiency of diagnosis and treatment of chronic obstructive pulmonary disease by determining the flow characteristics of COPD due to changes in acid - base status and acid secretory renal function in patients with COPD at different stages of the functional state of the lungs and in comparison with the data of patients with COPD comorbidity with nephropathy at early stages of lesion kidneys. A total of 117 patients with COPD, COPD II stage was diagnosed in 22 patients, mean age 51,95 ± 2,71 years, including 13 women and 9 men. The diagnosis of COPD III stage. was installed 44 patients, mean age 58,12 ± 1,16 years, including 21 women and 23 men. A separate group of patients was isolated with combined pathology of COPD (chronic obstructive pulmonary disease III stage with nephropathy). The group of patients with COPD III stage with associated nephropathy was formed after the screening of patients who were treated at the Regional Hospital. We examined 194 patients, 52.1% of cases (101 patients), revealed microalbuminuria (MAU). Evaluating lung function in patients with isolated lesions of the lungs and the control group, all indicators showed statistically significant differences (p <0.001), which in turn indicates the presence of COPD patients with significant air violations, both obstructive and to restrictive type. For the group of patients with COPD III stage with combined pathology was characterized by a decrease of all indices of respiratory function compared with the control group. Thus, all patients with COPD compared with the control group revealed violations of respiratory function both obstructive and restrictive type of the most significant - in patients with COPD III stage. Analysis indicates the presence of indicators for patients with COPD combined (respiratory and metabolic) acidosis, which increases with the progression of chronic obstructive pulmonary disease. These figures are typical for patients with combined pathology of COPD, which basically does not differ from that of patients with isolated pulmonary pathology. It should be noted that for patients with COPD who develop acidosis due to ventilation disorders are characterized by the inclusion in the compensation process of renal tubular mechanisms. Data analysis shows that the first increases daily excretion of titrated acids, which reaches its maximum value in patients with COPD II stage. and at the same level in patients with COPD remains III stage. In patients with COPD with nephropathy this index tends to increase, but the difference was not statistically significant. At the same time, the daily excretion of ammonia has a statistically significant increase on the whole interval of a pathological process in the lungs with the growth of disease severity. Thus, the analysis of these indicators suggest that, even in the most severe stages of COPD, there is activation of acid secretory renal function and renal mechanisms of inclusion in the regulation of acid - base balance Correction of acid - base balance of blood was carried out by the drug L - arginine and oxygen concentrator 7F - 5. The drug L - arginine has received 16 patients with COPD, both II and III century. Oxygen oxygenator was used in 11 patients with COPD III stage. The inclusion of a standard regimen antihypoxic treatment (L - arginine, oxygen) has a positive effect in reducing the symptoms of acidosis that accompanies the progression of COPD.
