摘要
目的:探讨动脉血气指标对肺血栓栓塞症(PTE)的诊断价值。方法:连续收集2006年1月至2011年3月北京安贞医院急诊监护病房的PTE患者110例,男性56例,平均年龄(64.09±14.02)岁。PTE经肺血管造影计算机断层成像和/或核素肺通气-灌注扫描确诊。同期纳入临床排除PTE的对照56例,男性30例,平均年龄(62.25±10.16)岁。评价反映肺泡过度通气及低氧血症的指标对PTE的诊断价值。结果:所有PTE患者中,与单纯应用PaCO2≤35 mmHg(1 mmHg=0.133 kPa)相比,应用组合指标pH≥7.45(呼吸性)或PaCO2≤35 mmHg可以提高诊断的敏感性(88.2%vs.74.5%,χ2=6.745,P=0.009)。应用SB-AB(标准碳酸氢盐与实际碳酸氢盐之差)≥0.5 mmol/L诊断所有PTE的敏感性与P(A-a)O2(肺泡-动脉氧分压差)异常相似(均为83.6%)。应用组合指标SB-AB≥0.5 mmol/L或P(A-a)O2异常诊断所有PTE的敏感性为96.4%,诊断无心肺疾病PTE的敏感性与阴性预测值均达到100%。结论:评估PTE临床可能性时,不仅要关注ABG指标的绝对值水平,更应寻找反映动态变化的征象。
Objective：This investigation aimed to evaluate the diagnostic value of arterial blood gas（ABG） measurement in pulmonary thromboembolism（PTE）.Methods：A total of 110 PTE patients [56 males;age（64.09 ± 14.02） years] admitted to the emergency intensive care unit of Beijing Anzhen Hospital,including acute or acute on chronic PTE,were consecutively recruited from January of 2006 to March of 2011.Computed Tomography pulmonary angiogram and ventilation-perfusion scan were used to validate or exclude PTE.Fifty-six age-and gender-matched controls [30 males;age（62.25 ± 10.16） years] were recruited into this study if they had no symptoms of PTE including dyspnea,syncope,or chest pain,and PTE diagnosis was excluded clinically.Arterial blood samples were collected from all study subjects while breathing room air.ABG analyses were performed on Critical Care Xpress.Prevalence of PaCO2 ≤ 35 mmHg（1 mmHg=0.133 kPa）,pH ≥ 7.45 induced by hyperventilation,SB-AB（difference between standard bicarbinate and actual bicarbinate） ≥0.5 mmol/L,PaO2 ≤ 80 mmHg,and abnormal P（A-a）O2（alveolar-arterial oxygen gradient） alone or in combination were compared with Chi-square test between all PTE patients and the controls.Sensitivity,specificity,positive and negative predictive values were determined for any variable or combination of variables reaching statistical significance.Results： Dyspnea was present in 90% of the 110 PTE patients,and 109（99.1%） out of all PTE patients presented with dyspnea,syncope,or chest pain.Compared with that of PaCO2 ≤ 35 mmHg（74.5%）,the sensitivity of PaCO2 ≤ 35 mmHg or pH ≥ 7.45 induced by hyperventilation in combination（88.2%） for the detection of all PTE was significantly higher（χ2=6.745,P = 0.009）.The sensitivity of SB-AB ≥0.5 mmol/L for detecting all PTE was similar to that of abnormal P（A-a）O2（both were 83.6%）.In combination of SB-AB ≥0.5 mmol/L or abnormal P（A-a）O2,the sensitivity for detecting all PTE was 96.4%.Among PTE patients without cardiopulmonary diseases,both sensitivity and negative predictive value of SB-AB ≥0.5 mmol/L or abnormal P（A-a）O2 in combination reached 100%.Conclusion： Our data indicate that ABG variables alone or in combination reflecting dynamic changes of homeostasis may be more sensitive and reliable for clinical assessment of PTE.
出处
《心肺血管病杂志》
CAS
2011年第6期494-497,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
肺血栓栓塞症
动脉血气
诊断
Pulmonary thromboembolism
Arterial blood gas
Diagnosis
