AECOPD与ARDS患者动脉血气特点及短期疗效比较

Comparative Analysis of Arterial Blood Gas Characteristics and Short-term Curative Effects in Patients with AECOPD and Patients with ARDS

目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)、肺外源性急性呼吸窘迫综合征(ARDSexp)和重症肺炎致肺内源性急性呼吸窘迫综合征(ARDSp)患者动脉血气特点及短期疗效。方法:对15例AECOPD患者(AECOPD组)、16例ARDSexp患者(ARDSexp组)、21例ARDSp患者(ARDSp组)在转入ICU时(0点)进行pH、动脉血二氧化碳分压(PaCO_2)、血氧分压(PaO_2)和碳酸氢根(HCO_3^-)等血气指标检测,并与同期收治的动脉血气结果正常患者(对照组)进行比较;分别对AECOPD、ARDSexp和ARDSp组在转入ICU时(0点)、治疗6 h(6 h点)及24 h(24 h点)3个时间点的pH、PaCO_2、PaO_2和HCO_3^-含量,呼吸机参数中吸入氧浓度(FiO_2)和呼气末正压(PEEP)和气压伤发生率进行比较。结果:在0点,与对照组比较,ARDSexp和ARDSp组的pH、PaO_2及HCO3-明显降低,ARDSexp和ARDSp组间血气结果无明显差异,AECOPD组与ARDSexp及ARDSp组比较,pH降低,PaO_2、PaCO_2及HCO3-升高(P<0.05);与同组0点和6 h点比较,AECOPD组和ARDSexp组在24 h点pH明显增高,ARDSp组pH值无明显变化;与同组0点比较,6 h点和24 h点AECOPD组PaCO_2明显降低(P<0.01),而ARDSexp和ARDSp组PaCO_2在三个时间点无明显变化;与同组0点比较,ARDSexp组和AECOPD组PaO_2治疗24 h后明显上升,而ARDSp组PaO_2无明显改善;与同组0点比较,ARDSexp及ARDSp组患者24 h点HCO_3^-升高,而AECOPD组HCO_3^-明显下降(P<0.01);从呼吸机参数来看,FiO_2从低到高分别为AECOPD组、ARDSexp组及ARDSp组,差异均具有统计学意义,AECOPD组使用的PEEP值明显低于ARDSexp组及ARDSp组(P<0.01);在使用相同呼气末正压(PEEP)机械通气条件下,ARDSp患者有2例发生气压伤(9.52%),而ARDSexp及AECOPD组未发生气压伤。结论:AECOPD患者血气容易被纠正,ARDSp患者低氧血症较ARDSexp重且难于被纠正,机械通气过程中ARDSp发生气压伤的风险较ARDSexp患者高。

Objective： To compare the arterial blood gas results and their short-term curative effects among patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） and patients with acute respiratory distress syndrome either induced by extrapulmonary injury（ ARDSexp） or by pulmonary injury（ ARDSp）,who were admitted to intensive care unit（ ICU）. Methods： Fifty-two patients with severe respiratory diseases（ 15 patients with AECOPD,16 patients with ARDSexp and the other 21 with ARDSp） were included,and their arterial blood gas characteristics and short-term curative effects were retrospectively analyzed at the time of ICU admission（ 0 h point）,6 hours（ 6 h point） and 24 hours（ 24 h point） after treatment. Patients with normal arterial blood gas results in the same period were regarded as control（ control group）. Results： Compared with control group,pressure of arterial oxygen（ PaO2） and HCO3^- were lower at 0 point in ARDSexp group and ARDSp group,but there were not significant differences between ARDSexp and ARDSp patients. pH,PaO2,HCO3^- and the pressure of arterial carbon dioxide（ PaCO2） in AECOPD patients were obviously different than the other three groups; the pH of AECOPD and ARDSexp at 24 h point were higher than at 0 point and6 h point,pH of ARDSp changed little through 24 hours; PaCO2 of AECOPD at 6 h point and 24 h point were obviously lower than at 0 point（ P 0. 01）,however there was no difference at these three time points in ARDSexp and ARDSp group; PaO2 of ARDSexp and AECOPD rised through the treatment of 24 hours,but ARDSp group changed little; the HCO3^- of ARDSexp and ARDSp at 24 h point were higher than at 0 point,however that of AECOPD decreased obviously（ P 0. 01）; Concerning the parameter of ventilator,the fraction of inspired oxygen（ FiO2） from high to low were AECOPD,ARDSexp and ARDSp group,the positive end-expiratory pressure（ PEEP） of AECOPD group were obviously lower than that of ARDSexp and ARDSp group（ P 0. 01）; ARDSp patients encontered barotrauma（ 9. 52%） while AECOPD as well as ARDSexp patients had no such experience in similar PEEP.Conclusion： AECOPD patients mainly suffer from respiratory failure type Ⅱ and it can be corrected easier in comparison to ARDS patients. ARDSp patients often experience more severe hypoxemia than ARDSexp do. ARDSp patients may be more susceptible to barotrauma than ARDSexp patients during machanical ventilation.