男性,75岁。反复咳嗽咳痰30余年，近半个月咳嗽咳痰加重伴双下肢水肿。査体：口唇发绀，双肺可闻及干湿啰音。经抗感染、利尿等治疗后症状有所好转。但2天后出现神志不清，手足搐搦。急査血气分析示：pH7.45,PaOa72mmHg,PaCX>268mmHg,HCOB. 44mmol/L,K+2.7mmol/L,Na+132mmol/L,Cl_67mmol/L0应诊断为

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