老年肺炎及肺癌合并感染伴胸腔积液者心功能不全的临床观察

目的探讨心功能不全与老年肺炎及肺癌伴胸腔积液的相关性。方法采用前瞻性对照研究，57例人选病例按病因诊断分为2组：肺炎合并胸腔积液组30例（肺炎组），肺癌合并感染伴胸腔积液组27例（肺癌组）。2组患者在对症治疗的基础上采用相同原则抗感染和强心、利尿的治疗措施。所有患者入院后依据NYHA分级标准评定心功能（Cardiacfunctionclassification，CFC）；并于入院后第1d和治疗后7d，为患者做胸部CT检查，超声测定心脏左心室舒张末内径（LVEDD）和左心室射血分数（LVEF），并同时检测血浆B型钠尿肽（BNP）浓度。结果肺炎组心衰的患病率（86．7％）明显高于肺癌组（14．8％），P〈0．01。治疗前肺炎组LVEF低于肺癌组（43．58±4．16比59．11±6．35，P〈0．01）；LVEDD高于肺癌组（62．43±7．94比48．18±5．12，P〈0．01）；BNP明显高于肺癌组（582．67±126．53比146．27±43.77），差异有统计学意义，P〈0．01。治疗7d后，肺炎组LVEF增加、LVEDD减小和BNP下降与治疗前比较，差异有统计学意义，P〈0．01；而肺癌组治疗前后LVEF、LVEDD和BNP均无明显变化，P〉0．05。肺炎组胸腔积液的治疗效果70．0％（21／30）的患者完全吸收，16．7％（5／30）部分吸收，13．3％（4／30）无吸收]明显优于肺癌组18．5％±5／27）部分吸收，81．5％（22，27）无吸收，P〈0．05]。结果表明，肺炎组的治疗效果与BNP下降、LVEDD减小和LVEF增加相一致。结论心功能不全在老年肺炎伴胸腔积液者有很高的发生率，动态监测患者BNP水平、LVEF和LVEDD的变化，对指导心功能不全相关性胸腔积液的诊断和治疗有重要的临床意义。

Clinical observation of cardiac insufficiency in those elderly with senile pneumonia or lung cancer accompanied by pleural effusion

Objective To observe the correlation between cardiac insufficiency and pleura] effusion in elderly who were suffering from pneumonia or lung cancer. Methods A prospective study was carried out to investigate 57 emergently hospitalized patients with pleura] effusion, and according to the etiology, they were divided into two groups： a senile pneumonia group （30 cases） and a lung cancer group （27 cases）. The same therapeutic measures were taken in the two groups, such as, anti-infection, enhancement of cardiac function, dieresis, and limitation of the amount of liquid intake. After admission, every patient＇ s cardiac function was determined according to the gradation of the New York Heart Association （NYHA）. Respectively, all the patients took the CT scan of the chest before the treatment and on the 7th day after treatment, and at the same time, left ventricular end-diastolic diameter （LVEDD）, left ventricular ejection Fraction （LVEF） and plasma concentrations of B-type natriuretic peptide （BNP） were detected. Results 1. The incidence of congestive heart failure （CHF） in pneumonia group was significantly higher than that in lung cancer group （86.7% vs. 14.8%, P〈 0.01）. 2. Before treatment, LVEF in pneumonia group was lower than that in group of lung cancer （43.58±4.16 vs.59.11±6.35, P〈0.01）, LVEDD and BNP were significantly higher than that in lung cancer group （62.43±7.94 vs.48.18± 5.12; 582.67 ± 126.53 vs.146.27 ±43.77, respectively, P〈 0.01）. Compared that with before treatment, after treatment the BNP and LVEDD declined down and LVEF increased up in pneumonia group （P〈 0.01）. Nevertheless, LVEDD or LVEF and BNP no vary in lung cancer group （P 〉0.05）. 3. The therapeutic effect that pleura] effusion was absorbed in pneumonia group % （cases） ] was much superior to that in lung cancer group completely 86.7% （21/30）, partly 16.7% （5/30） and no 13.3% （4/30） vs. respectively 0（0/27）,18.5%（5/27） and 81.5%（22/27）, P〈 0.013. The results showed that the treatment effect was consistent with the decreased of BNP and increased of LVEF of in pneumonia group. Conclusion There is a high incidence of cardiac insufficiency in patients with senile pneumonia accompmlied by pleural effusion. It is very important to monitored dynamically the concentration of plasma BNP and the change of LVEDD and LVEF for guiding the diagnosis and treatment of pleural effusion with cardiac insufficiency.