慢性肺源性心脏病急性加重期患者血气酸碱变化对预后的影响  

The effect of the variation of the vigour acid-base and the venous blood electrolyte on the progrosis in the chronic pnlmonary heart diseas aucte aggravative period

作　　者：张清祥 邱汉辉 曾胜宏 周庆辉 黄永青 

机构地区：[1]广东梅县人民医院,514011

出　　处：《中国基层医药》2005年第8期979-981,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察慢性肺源性心脏病急性加重期血气酸碱及静脉血电解质变化对其预后的影响.方法将96例慢性肺源性心脏病急性加重期患者进行血气、酸碱及静脉血电解质三者进行同步检测,通过观察血气、酸碱及静脉血电解质的变化与患者的预后的关系.结果 pH<7.30者37例,死亡9例(24%),与7.30～7.50组比较差异有非常显著意义(P＝0.0359),其中pH<7.20者13例,死亡7例(53.8%),7.20～7.29者24例,死亡2例(8.3%),两者差异有非常显著意义(P＝0.0074),pH>7.50者病死率甚高,达50%;动脉血氧分压(PaO2)<80 mmHg、动脉二氧化碳分压(PaCO2)>50 mmHg、K+>5.5 mmol/L时病死率均显著升高,与对照组比较差异有非常显著意义;酸碱失衡类型中以呼碱并代碱病死率最高,其次是呼酸并代酸.示pH值是影响慢性肺源性心脏病急性加重期患者的重要因素,pH值越低,预后越差;低氧血症、二氧化碳潴留、酸碱失衡类型、高血K+、低血K+与预后有密切关系;缺K+增加病死率.结论血气酸碱及心肌酶的变化与慢性肺源性心脏病急性加重期患者的预后有密切的关系.Objective Observing the variation of the vigour acid-base and the venous blood electrolyte and its prognosis effect in the chronic pnlmonary heart disease acute aggravative period. Methods Giving synchronous detection to 96 sufferers of the chronic pnlmonary heart disease in acute aggravative period by vigour,acid-base and venous blood electrolyte,through observing to know the relationship between the variation of vigour,acid-base and venous blood electrolyte and the prognosis of the sufferers. Results 37 case pH 〈 7.30,9 cases death（24% ）, compared with the 7.30～7.50 group,the difference has high significance（ P = 0. 0359）,among which, 13 eases pH 〈 7.20,7 cases death（53.8 % ）, 24 cases 7.20 ～7.29,2 cases death（8.3 % ）, the difference between the two has high significance（P = 0. 0074）. The case-fatality rate is rather high for the ones whose pH 〉 7.50, reached 50 % ; When oxygen partial pressure of arterial blood（PaO2 ） 〈80mmHg,carbon dioxide partial pressure of arterial blood（PaCO2） 〉 50mmHg, K^＋ 〉 5.5mmol/L, the case-fatality rate is uprised obviously, the difference has high significance; Compared with the control group in the types of the unbalance of acid-base, the case-fatality rate of respiratory alkalosis and metabolic alkalosis is the highest, the second is respiratory acidosis and metabolic acidosis, pH is the important factor to have an effect on the chronic pnlmonary heart disease in acute aggravative period. The lower pH, the weaker the prognosis; Hypoxemia, carbon dioxide retention, the unbalance of acid-base type, hyperkalemia, hypokalemia, all these have close relationship with prognosis; The shortlessness of K^＋ increases the case-fatality rate. Conclusion The variation of the vigour acid-base and the heart muscles enzyme has close relationship with the prognosis of the sufferers in acute aggravative period.

关 键 词：肺心病 血气分析 酸碱平衡失调 慢性肺源性心脏病 急性加重期 酸碱变化 血气酸碱 预后 患者 血电解质变化 

分 类 号：R541.5[医药卫生—心血管疾病] R657.3[医药卫生—内科学]