肺心病死亡原因探讨

目的:探讨肺心病死亡原因,方法:①选取1977～1997年住入我院的肺心病患者,随访5年期间死亡43例及存活33例得患者进行首诊各项检测对比。②对并发消化道出血及感染性休克患者死亡前24～72h行血流动力学及氧合状态监测。结果:①直接死亡的43例患者主要原因为消化道出血15例(34.9%),感染性休克11例(25.6%)。②死亡年限愈短,MPAP愈高,CI、DO2、PaO2愈低。③死亡的43例患者临终前均有酸碱平衡紊乱及心电图改变,25例(58.13%)痰菌培养出致病菌57株。④肺心病感染性休克死亡前的血流动力学特点是MPAPP、CI、DO2、均增高,分别为(31.8±81)mmHg、(4.1±0.9)L·min-1·m-2、(555.7±98.1)ml·min-1·m-2,但CaO2-CvO2明显降低为(3.2±0.4)ml·dl-1。结论:①机械通气虽然可降低肺性脑病的病死率,但肺心病死亡率仍高,其直接死亡原因以消化道出血及感染性休克为主。②并发感染性休克的缺氧除气流受限外,组织的氧利用及摄取障碍亦是主要原因。

Study on causes of death for pulmonary heart disease

Objective To study the causes of death for pulmonary heart disease. Method ①76 patients with pulmonary heart disease admitted to our hospital from 1977 to 1997, 43 cases were dead and 33 alive after five years' follow-up. Their initial examination results were analyzed. ②hemodynamics and oxygenation state were supervised on patients combined with gastrointestinal hemorrhage or septic shock 24~72h before death. Results ①Of 43 deaths, 15 died from gastrointestinal hemorrhage (34.9%) and 11 from septic shock (25.6%). ②Patients with higher MPAP lower CI, DO2 and PaO2 had shorter survival time. ③All the deaths had acid-base disturbance and abnormal ECG just before dying and 25 case (58.13%) of bacterium cultivations of sputum were positive. ④Patients combined with septic shock had higher MPAP, CI and DO2 [(31.8±81)mmHg, (4.1±0.9)L·min-1·m-2, (555.7±98.1)ml·min-1·m-2 respectively] on hemodynamics and lower CaO2-CvO2 [(3.2±0.4)ml·dl-1]. Conclusion ①Although mechanical ventilation can decrease case fatality rate, the death rate of pulmonary heart disease is still very high. The leading causes of death are gastrointestinal hemorrhage and septic shock. ②Except for hypoventilation, dysfunction of oxygen uptake and utilization may also lead to hypoxia on patients combined with septic shock.