肺泡动脉血氧分压差检测在肺部感染致急性呼吸窘迫综合征患者治疗中的临床意义

Clinical significance of pulmonary alveolar arterial oxygen partial pressure difference in treatment of acute respiratory distress syndromecaused by pulmonary infection

目的研究肺泡动脉血氧分应差(alveolar-arterial oxygen partial pressure difference,PA-aDO2)检测在肺部感染致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者治持中的临床意义。方法回顾性分析贵州医科大学附属医院2017年3月-2018年3月收治的72例肺部感染致ARDS患者临床资料,设为观察组,另外选取本院同期体检健康的72名志愿者纳入研究对象,设为对照组。对比两组基础资料及实验室检查结果[性别、年龄、身体质量指数(body mass index,BMI)、收缩压(systolic Blood Pressure,SBP)、舒张压(dia-stolicbloodpressure,DBP)、丙氨酸转氨酶(alanineaminotransferase,ALT)、天门冬氨酸氧基转移酶(aspartate amino-transferase,AST)、一秒用力呼气容积(forcedexpiratory volume in one second,FEVI)、一秒用力呼气容相/用力肺活量比值(Forced expiratory volumein one second/Forced vital capacity ratio,FEV1/FVC)、最大通气量(maximum ventilation volume,MW)、氧合指数(oxygenation index,PaO2/FiO2)、PA-aDO2],观察组患者入院后行化痰、抗感染、机械通气等治疗措施,通气14 d后依据脱机情况分为亚组Ⅰ(n=38)及亚组Ⅱ(n=34),对比两组患者FEV1、FEV1/FVC、MVV、PaO2/FIO2、PA-aDO2水平差异,最后以Spearman相关系数分析.PA-aDO2与FEV1、FEV1/FVC、MVV、PaO2/FIO2的相关性。结果两组性别、年龄、BMI、SBP、DBP、ALT、AST对比差异无统计学意义(P>0.05);观察组FEV1、FEV1/FVC、MVV、PaO2/FiO2水平显著低于对照组,差异有统计学意义(P<0.05);观察组PA-aDO2水平显著高于对照组,差异有统计学意义(P<0.05)。亚组Ⅰ FEV1、FEV1/FVC、MW、PaO2/FiO2水平显著高于亚组Ⅱ,差异有统计学意义(P<0.05);亚组Ⅰ PA-aDO2水平显著低于亚组Ⅱ,差异有统计学意义(P<0.05)。经相关性分析PA-aDO2与FEV1、FEV1/FVC、MVV、PaO2/FiO2呈现出负相关,均有(P<0.05)。结论PA-aDO2与FEV1、FEV1/FVC、MVV、PaO2/FiO2关系密切,在机械通气治疗肺部感染致ARDS时应当密切关注。

Objective To investigate the clinical significance of alveolar-arterial oxygen partial pressure difference(pa-ado2)in the treatment of acute respiratory distress syndrome(ARDS)due to pulmonary infection.Methods The clinical data of 72 patients with ARDS caused by pulmonary infection admitted to our hospital from March 2017 to March 2018 were retrospectively analyzed,and were set as the observation group.In addition,72 volunteers who were healthy during physical examination in our hospital during the same period were selected as the study subjects and set as the control group.Basic data and laboratory examination results of the two groups were compared[gender,age,body mass index(BMI),Systolic Blood Pressure(SBP),diastolicbloodpressure(DBP),alanineaminotransferase(ALT),aspartate aminotransferase,AST),forcedexpiratory volumein one second(FEV1),Forced expiratory volumein one second(FEV1/FVC),maximum ventilation volume,MW,oxygenation index(Pa02/Fi02/),pa-ad02/],Observation group of patients admitted to hospital after phlegm,anti-infection and mechanical ventilation treatment measures,such as ventilation based on offline after 14 d is divided into subgroups ⅠⅡ(n=38)and the group(n=34),compared two groups of patients with FEV1,FEV1/FVG,MW is,PaO2//FiO2/,PA-aDO2/level differences,finally to PA-aDO2/Spearman correlation coefficient analysis with FEV1,FEV1/FVC,MVV is,PaO2//FiO2/relevance.Results There was no significant difference in gender,age,BMI,SBP,DBP,ALT and AST between the two groups(all P>0.05).The levels of FEV1,FEV1/FVC,MW and PaO2/FiO2 of the observation group were significantly lower than those of the control group(all P<0.05).The level of PA-aDO2 of the observation group was significantly higher than that of the control group(P<0.05).Subgroups Ⅰ FEV1,FEV1/FVG,MW is Ⅱ,PaO2/FiO2 level is significantly higher than the group,the difference was statistically significant(P<0.05);Subgroups Ⅰ PA-Ⅱ aDO2 were significantly lower than the group,the difference was statistically significant(P<0.05).The correlation analysis showed that PA-aDO2 was negatively correlated with FEV1,FEV1/FVC,MW and PaO2/FiO2(all P<0.05).Conclusion PA-aD02 is closely related to FEV1,FEV1/FVC,MW and PaO2/FiO2.It should be paid close attention to when mechanical ventilation is used to treat ARDS caused by pulmonary infection.