急性肺血栓栓塞症血气分析的临床意义

目的:观察急性肺血栓栓塞症(肺栓塞)时血气指标的变化,评估血气分析在急性肺栓塞诊断和治疗中的作用.方法:资料来源于急性肺栓塞溶栓及抗凝治疗多中心临床试验,回顾性分析107例既往无心肺疾病的急性肺栓塞患者动脉血气结果.结果:呼吸困难是最常见的临床症状,占89.7%(96/107).107例血气分析表明动脉血氧分压(PaO2)正常者19例,占17.8%,PaO2降低的敏感性为82.2%.当两个指标综合考虑时,PaO2降低或动脉血二氧化碳分压(PaCO2)降低的敏感性为91.6%,PaCO2降低或肺泡-动脉血氧分压差[P(A-a)O2]升高的敏感性为98.1%,只有2例患者P (A-a)O2和PaCO2均正常.结论:PaCO2和P(A-a)O2均正常可作为排除急性肺栓塞的重要依据.

Diagnostic Value of Arterial Blood Gas Analysis in Acute Pulmonary Thromboembolism

Objective:To evaluate the diagnostic value of arterial blood gas analysis in acute pulmonary thromboembolism. Methods:Data from a multicenter clinical trial for patients with acute pulmonary embolism treated with thrombolysis and /or anticoagulation were collected.Retrospective analysis was performed for arterial blood gas in 107 patients with pulmonary thromboembolism who had no prior cardiopulmonary disease. Results:Dyspnea was a most common symptom (89 7%). Nineteen of 107 patients showed a normal PaO 2 The sensitivity of PaO 2 decrease was 82 2%.Either a decreased PaO 2 or a decreased PaCO 2 was observed in 98 of 107,with a sensitivity of 91 6%. Either a decreased PaCO 2 or increased P(A a)O 2 gradient was observed in 105 of 107,yielding a sensitivity of 98 1%.Only 2 patients had normal PaCO 2 and P(A a)O 2 gradients. Conclusion:Normal PaCO 2 and P(A a)O 2 gradients can be used as evidence to rule out acute pulmonary thromboembolism.