自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

Study of automated acid-base mapping on diagnose and treatment of community acquired pneumonia in emergency department

目的探讨自动化酸碱平衡图在急诊科社区获得性肺炎（CAP）患者诊断中的价值。方法根据病史、肺功能测定结果、慢性阻塞性肺疾病（COPD）诊断标准，将111例CAP患者分为单纯CAP组（56例）和COPD合并CAP组[即慢性阻塞性肺疾病急性加重（AECOPD）组，55例]。询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析。结果血气分析结果显示，AECOPD组动脉血二氧化碳分压（PaCO2，kPa）、HCO3-（mmol／L）、剩余碱（BE，mmolFL）均显著高于CAP组（PaCO2：7．714±2．414比5．896±1．308，HCO3-：30．767±7．185比25．014±3．043，BE：4．345±5．371比-0．354±3．180，均P〈0．01）。自动化酸碱平衡图分析结果显示，AECOPD组患者酸碱平衡紊乱高达89．1％，CAP组为66．1％。将AECOPD组和CAP组患者中正常（10．9％、33．9％）、急性呼吸性酸中毒（急性呼酸，12．7％、14_3％）、慢性呼吸性酸中毒（慢性呼酸，49．1％、10．7％）、呼吸性碱中毒（呼碱，7．3％、14．3％）、代谢性酸中毒（代酸，12．7％、17．9％）、代谢性碱中毒（代碱，12．7％、8．9％）综合进行X2分析，差异有统计学意义（x2=24．421，P=0．001），而将正常、急性呼酸、呼碱、代酸及代碱进行x。分析，差异无统计学意义（X2=5．280，P=0．260），提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加。结论自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱，并可快速识别急、慢性呼吸系统疾病。

Objective To analyze the value of automated acid-base mapping on diagnose and treatment of patients with community acquired pneumonia （CAP） in emergency department. Methods According to medical history, pulmonary function test, diagnosing guideline of chronic obstructive pulmonary disease （COPD）, 111 patients with CAP were divided into two groups： single CAP group （n=56） and COPD complicated with CAP group [acute exacerbation of chronic obstructive puhnonary disease （AECOPD） group, n =551. After enquiring medical history, arterial blood samples were drawn for blood gas analysis and automated acid-base mapping was analyzed. Results Arterial blood gas analysis showed arterial carbondioxide partial pressure （PaCO2, kPa）, HCOf （mmol/L）, base excess （BE, mmol/L） of AECOPD group were obviously higher than those in CAP group （PaCO2：7.714 ± 2.414 vs. 5.896 ± 1.308, HCO3 ： 30.767 ± 7.185 vs. 25.014 ± 3.043, BE： 4.345 ±5.371 vs. -0.354 ± 3.180, all P〈0.01 ）. Automated acid-base mapping showed acid-base disturbance of AECOPD group was 89.1% and CAP group was 66.1% . Chi-square analysis were done for patients of normal （ 10.9%, 33.9%）, acute respiratory acidosis （ 12.7%, 14.3%）, chronic respiratoryaeidosis （49.1%, 10.7%）, respiratory alkalosis （7.3%, 14.3%）, metabolic acidosis （12.7%, 17.9% ）, metabolic alkalosis （ 12.7%, 8.9% ） between AECOPD group and CAP group, and statistical significance was found between AECOPD group and single CAP group （ X 2=24-421, P=0.O01 ）. Advanced Chi-square analysis for patients of normal, acute respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis were done and showed no statistical difference （ X 2=5.280, P=0.260）. It is indicated chronic respiratory acidosis occurrences rate in AECOPD patients was higher than single CAP patients. Conclusions Our study demonstated that automated acid-base mapping may be helpful for emergency physician to rapidly recognize multi-acid-base disturbance in patients with CAP, and to promptly indentify acute or chronic phase of respiratory disease.