肺泡死腔分数对急性肺栓塞病情的评估价值

Alveolar Dead Space as a Predictor of Severity and Reperfusion of Pulmonary Embolism

目的评价肺泡死腔分数(ADSF)测定对急性肺栓塞病情评估的作用。方法连续入选39例急性肺栓塞患者进行前瞻性研究,根据栓塞面积将患者分为大范围栓塞组(LPE)和小范围栓塞组(SPE),分别接受溶栓和抗凝治疗或单纯抗凝治疗。30 d后进行CT肺血管造影(CTPA)或核素通气/灌注(.V/.Q)显像,确定阻塞血管的再通程度。治疗前和治疗后30 d,测定患者呼气末CO2(PETCO2)和动脉血气,根据PETCO2和PaCO2计算ADSF。结果 39例APE患者中,18例(46.2%)为LPE组,21例(53.8%)为SPE组。治疗前LPE组的ADSF明显高于SPE组(0.34±0.078比0.18±0.027,P<0.05)。治疗后30 d,21例患者阻塞血管完全再通,再通后ADSF较治疗前明显下降(0.09±0.04比0.28±0.11,P<0.01)。结论床旁ADSF监测能够反映血栓范围和再通情况,有助于急性肺栓塞患者的病情评估。

Objective To assess the predictive value of alveolar dead space fraction（ADSF） for severity and reperfusion of acute pulmonary embolism（APE）.Methods 39 consecutive patients with APE were enrolled in a perspective study from July 2004 to March 2007.All patients were divided into a large pulmonary embolism group（LPE） and a small pulmonary embolism group（SPE） based to the mass and location of the embolus.The patients of the LPE group received thrombolytic therapy and anticoagulation,while the patients of the SPE group received anticoagulation only.CTPA or lung scintigraphy was performed before and after treatment to confirm the resolve condition of the embolism after treatment. Pressure of end-expired carbon dioxide（PETCO2） and blood gas analysis（including PaCO2） were measured at the time of run-in and 30 days after treatment by bedside.ADSF was calculated by PETCO2 and PaCO2.Results Among 39 APE patients,there were 18 patients in the LPE group,while 21 in the SPE group.The ADSF of the LPE group before treatment were higher than that of the SPE group（0.34±0.078 vs.0.18±0.027,P0.05）.The ADSF decreased significantly after treatment in the patients with full reperfusion（0.09±0.04 vs.0.28±0.11,P0.01）.Conclusion As a bedside test,ADSF can reflect the mass of embolism and the reperfusion condition,and is useful in monitoring the disease.