急性左心衰竭患者动脉血红细胞内外血气变化和酸碱失衡的研究

Changes of arterial intra- and extra-erythrocytic blood gases in patients with severe acute left heart failure

目的观察急性左心衰竭患者动脉血红细胞内外血气变化特点。方法以2009年1月至2012月12月收治的急性左心衰竭患者57例作为观察组,从体检者中抽取57名健康志愿者为对照组;采用血气分析测定健康者及急性左心衰竭患者治疗前、治疗后动脉血酸碱指标pH(PeH)、PCO2(PeCO2)、PO2(PeO2)、HCO3-(HeCO3-),采用冰融法测定红细胞内酸碱指标pH(PiH)、PCO2(PiCO2)、PO2(PiO2)、HCO3-(HiCO3-)。比较急性左心衰竭患者与健康者的动脉血红细胞内外酸碱指标差异以及急性左心衰竭患者治疗前后动脉血红细胞内外酸碱指标的变化特点。结果①左心衰竭患者治疗前PeH低于健康组(P<0.05),PiH高于健康组(P<0.05),治疗后PeH比治疗前显著增加(P<0.05),PiH有所降低,但与治疗前差异无统计学意义(P>0.05),治疗后PeH、PiH与健康组比较差异均无统计学意义(P>0.05);②左心衰竭组治疗后PeO2、PiO2仍低于健康组(P<0.05),PeCO2、HeCO3-、PiCO2、HiCO3-仍高于健康组(P<0.05),但治疗后血红细胞内外酸碱指标差值△pH、△PCO2、△PO2、△HCO3-比治疗前显著改善,△pH、△PCO2、△HCO3-与健康组比较差异无统计学意义(P>0.05)。结论急性左心衰患者在病理情况下细胞内外酸碱出现逆向改变,血红细胞内相对偏碱程度加大,治疗缓解后血红细胞内外酸碱度可恢复正常。

Objective To study the changes of arterial intra- and extra-erythrocytic blood gases in patients with severe acute left heart failure. Methods Fifty-seven patients with severe acute left heart failure in our hospital from Jan. 2009 to Dec. 2012 were assigned as the observation group, and 57 healthy physical examinees were assigned as the control group. The changes of blood gases of in （Pill, PiCO2, PiO2, HiCO3-） and out （Pert, PeCO2, PeO2, HeCO3-） of the erythrocytes in the arteries were observed, and the findings were compared between the two groups. Results ① Before treatment, Pert of the observation group was significantly lower than that of the control group （P〈 0.05）, and Pill was significantly higher than the control group （P〈0.05）; There was no differences between the observation group and the control group after treatment in Pert, Pill （P〉0.05）. ② PeO2, PiO2 of the observation group were significantly lower than that of the control group （P〈0.05）, PeCO2, HeCO3-, PiCO2, HiCO3- of the observation group were significantly higher than that of control group （P〈0.05）, but/X pH, △PCO2, △ PO2, A HCO3- of the observation group were no further different from that of the control group. Conclusion Arterial intraerythrocytic alkilinization is likely to increase along with the aggravation of disease in patients with severe acute left heart failure. When remission of cor pulmonale is achieved after therapeutic measures, normal acid-base ratio of arterial blood gases in and out of erythrocytes can be restored.