肺泡动脉氧分压差、D-二聚体和肌钙蛋白T在肺癌术后呼吸困难鉴别诊断中的意义

目的 探讨肺癌术后急性呼吸困难患者肺泡动脉氧分压差P(A-a)O_2]、D-二聚体和肌钙蛋白T(cTnT)对鉴别诊断的意义.方法 以我院2007年1月1日至2009年9月30日收治的肺癌术后急性呼吸窘迫综合征(ARDS)、急性肺栓塞、急性左心衰竭各43例患者为研究对象,分析各组血气资料中P(A-a)O_2以及血浆D-二聚体和cTnT的差别.结果 ARDS组、急性肺栓塞组与急性左心衰竭组血气资料均存在不同程度P(A-a)O_2分别为(44.1±11.7)、(47.3±15.6)、(58.81±9.9)mm Hg]增大,以急性左心衰竭增加最为明显(P均<0.01).ARDS组和急性左心衰竭组血浆D-二聚体分别为(378.53±66.79)、(397.86±97.0 80)μg/L]轻度升高,而急性肺栓塞组血浆D-二聚体(4475.73±1109.25)μg/L]明显升高(P均<0.01).ARDS组血浆cTnT在正常参考范围(0.04±0.02)mg/L],而急性肺栓塞组和急性左心衰竭组血浆cTnT有不同程度的升高分别为(0.19±0.04)、(0.26±0.05)mg/L,P均<0.01].结论 利用血气分析、D-二聚体和cTnT检查,结合临床对鉴别诊断肺癌术后急性呼吸困难病例如ARDS、肺栓塞、急性左心衰竭等有很高的实用价值.

Significance of P(A-a)O_2,D-dimer and troponin T for emergency dyspnea in postoperative lung cancer patients

Objective To investigate the change of P(A-a) O_2,D-Dimer and troponin T at emergency dyspnea in postoperative lung cancer patients.Methods Three types of lung cancer patients were chosen for analysis (acute respiratory distress syndrome,acute pulmonary embolism and acute left heart failure) from the 1 st of January,2007 to the 30th of September,2009 in our hospital,with 43 cases in each group.The items for cutuparison included P(A-a)O_2,D-Dimer and troponin T.Results Hypoxemia and high P(A-a)O_2 occured in all patients.The level of P (A-a)O_2 is the highest in acute left heart failure patients((58.81±9.9)mm Hg).There were very higher D-dimer in acute pulmonary embolism patients,and mildly increased in acute respiratory distress syndrome patients and acute left heart failure patients.There were higher troponin T in acute pulmonary embolism patients and acute left heart failure patients,and normal in acute respiratory distress syndrome patients.Conclusions Blood gas measurement of P(A-a)O_2,D-Dimer,troponin T combine with clinical situation,are useful in diagnosis of emergency dyspnea patients in postoperative lung cancer patients.