急性心肌梗死肺泡动脉血氧分压差及肺功能的研究

ALTERATIONS IN ALVEOLAR-ARTERIAL OXYGEN GRADIENT AND PULMONARY FUNCTION IN ACUTE MYOCARDIAL INFARCTION

目的：探讨急性心肌梗死（AMI）患者肺泡动脉血氧分区差及肺功能与心功能受损程度的相关性。方法：对35例AMI患者据心功能（Killip）分级不同进行分组，分别行血气分析和肺功能各指标（FEV1.0、FVC、V50及V25）监测，并计算肺泡动脉血氢分压差（A－aDO2）。比较各组间上述指标的差别。结果：AMI当日即有动脉血氧分压（PaO2）的下降，A-aDO2。的增大，并随病情改善而渐趋恢复。PaO2及肺功能各指标在各组间差别具有统计学意义（P＜0．05）。不同的梗塞部位A－aDO2亦不同，差别具有统计学意义（P＜0．05）。结论：在AMI患者测定PaO2、A－aDO2及肺功能指标对评价心功能状况具有重大意义，值得在临床工作中推广应用。

Aim: This study collected 35 cases suffering from acute myocardial infarction (AMI) to reaveal the effect of ventricular dysfunction on respiratory system. Methods: Each patient was placed into one of four clinicalclasses with respect to Killip classification on AMI. Arterial blood gas analysis was made in the first day and repeated after three or four weeks. At the same time, alveolar-arterial oxygen gradient (A-aDO2) was calculated by assuming a respirary quotient equal to 0. 8. On the other hand, all the patients were taking pu1monary function testin the first, second and third week respectively. Results: PaO2 decreased in all subjects. It was mild in 17 (group 1), moderate in 10 (group 2) and severe in 8 (group 3 and group 4).Furthermore, there was significant difference among these groups (P<0.05). Compared the results of A-aDO2 before and after treatment, significant disparity (P<0.01) could be found. To each group, the fina1 result of pulmonary function test significantly differ from the primary one (P<0.01). Compared with group 1, mean FVC, FEV1.0,V25, V50 percent predicted were significantly lower in other groups (P<0.05 or P<0.01). There is no significant difference between group 2 and group 3 (P>0.05). Conclusion: Lung functiPn test is valueful in left ventricular dysfunction from AMI. There is a high correlation between the reduction in arterial PaO2and the severity of pulmonary vascular congestion. The increased A-aDO2 and changes of pulmonary function correlated with the severity of left ventricular dysfunction.