肺心病死亡原因探讨  

Study on causes of death for pulmonary heart disease

作　　者：秦伟毅[1] 邹霞英[1] 辛达临[1] 钱洪津[1] 苏磊[1] 

机构地区：[1]广州军区广州总医院,广东广州510010

出　　处：《吉林医学》2006年第9期1047-1049,共3页Jilin Medical Journal

摘　　要：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。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.

关 键 词：肺心病 死亡原因 血流动力学 

分 类 号：R541.5[医药卫生—心血管疾病]