重症及危重症甲型H1N1流感患者血气分析及电解质水平变化研究

Changes of Blood Gas Analysis and Electrolyte in Patients with Severe and Critical Influenza A( H1N1 )

目的探讨重症及危重症甲型H1N1流感患者血气分析变化及血清电解质水平改变。方法纳入206例咽拭子rt-PCR阳性甲型H1N1流感患者,其中重症28例(重症组),危重症25例(危重症组)。入院后及时采集动脉血进行血气分析检查,同时检查血生化指标,对两组血气分析及电解质结果进行分析。结果危重症组pH与重症组比较差异无统计学意义(P>0.05)。危重症组动脉血氧分压(PaO2)〔(68±26)mm Hg比(87±21)mm Hg〕、氧合指数(PaO2/FiO2)〔(190±67)比(381±47)〕低于重症组,两组比较差异有统计学意义(P<0.01)。危重症组血清Ca2+〔(1.93±0.45)mmol/L比(2.13±0.25)mmol/L〕及P3+〔(1.01±0.25)mmol/L比(1.28±0.51)mmol/L〕低于重症组,两组比较差异有统计学意义(P<0.05)。Pearson相关分析显示,甲型H1N1流感的严重程度与PaO2(r=-0.390)、PaO2/FiO2(r=-0.862)、K+(r=-0.076)、Ca2+(r=-0.273)、P3+(r=-0.323)呈负相关(P<0.05),与肺泡-动脉血氧分压差〔P(A-a)O2,r=0.601〕、pH(r=0.213)呈正相关。重症、危重症甲型H1N1流感患者血清K+、P3+与pH呈负相关(r值分别为-0.208、-0.047,P值分别为0.043,0.049)。结论重症、危重症甲型H1N1流感患者出现呼吸衰竭及电解质紊乱,PaO2、PaO2/FiO2、Ca2+、P3+的降低可以作为判断疾病危重程度的指标。

Objective To investigate the changes of blood gas analysis and electrolyte levels in patients with severe and critical influenza A （ H1N1 ） . Methods Totally 53 patients with A H1N1 influenza, confirmed by positivity rt - PCR of throat swab, were classified into severe group （ n = 28 ） and critical group （ n = 25 ） . The tests of blood gas analysis and electro- lyte were performed, and the results were studied. Results Compared with the severe group, in the critical group pH value was higher but with no significant difference （P 〉 0. 05 ） ; the levels of PaO2 [ （68 ± 26 ）mm Hg vs. （87 ± 21 ）mm Hgl and PaOJFiO2 I （ 190± 67） vs. （ 381 ± 47） ] were lower significantly （ P 〈 0. 01 ） ; the levels of serum Ca2 ＋ [ （ 1.93 ± 0. 45 ） mmol/L vs. （2. 13 ±0. 25） mmoL/L] and p3＋ [ （1. 01 ＋0. 25） mmol/L vs. （1.28±0, 51） mmol/L] were lower significantly （P 〈 0. 05 ） . Pearson correlation analysis showed that the severity of influenza A （H1N1） was negatively correlated with levels of PaO2 （r= -0.390）, PaO2/Fi02 （r = -0.862）, serum K＋（r = -0.076）, Ca2 ＋ （r = -0.273） and p3＋ （r = -0. 323） ; and positively correlated with level ofP （A -a） 02 （r =0. 601） and pH （r =0. 213） . The levels of serum K＋ and p3 ＋were negatively correlated with the value of pH （ r = - 0. 208, - 0. 047 ; P = 0. 043, 0. 049 ） . Conclusion The patients with severe and critical influenza A （ H1 N1 ） have respiratory failure and electrolyte disturbance, and the lower levels of Pa02, PaO2/FiO2, serum Ca2 ＋and p3 ＋ may serve as the indicators of the severity of illness.