肺泡死腔分数在肺血栓栓塞症诊治中的价值  

Clinical value of alveolar dead space fraction in diagnosis and treatment of pulmonary thromboembolism

作　　者：韩伟[1] 唐华平[1] 王欣[1] 李双保[1] 郝月琴[1] 

机构地区：[1]山东省青岛市市立医院,山东青岛266071

出　　处：《中国现代医学杂志》2010年第22期3488-3490,3493,共4页China Journal of Modern Medicine

基　　金：青岛市科技发展计划项目(No:KZD-30)

摘　　要：目的评价床旁肺泡死腔分数(ADSF)测定在肺血栓栓塞症(PTE)诊断和治疗中的作用。方法在2004年7月～2007年3月对352例可疑PTE患者进行前瞻性调查。测定PaCO2、呼气末二氧化碳(PETCO2),计算ADSF。对比PTE患者和非PTE患者的ADSF,以及PTE患者治疗前和治疗后30d的ADSF。结果 39例患者确诊为PTE,其ADSF均明显高于非PTE者(0.228+0.100)v(s0.120+0.030),P<0.05)。ADSF阳性诊断肺栓塞的灵敏度为71.8%,特异度为95.8%,阳性似然比(LR+)为17.95,阴性似然比(LR-)为2.94。21例完全再通的PTE患者治疗后30d的ADSF(0.09±0.04)较治疗前ADSF(0.28±0.11)明显下降(配对t检验P<0.01)。结论 ADSF作为一项方便的床旁监测项目,有助于肺血栓栓塞症的诊断和治疗。【Objective】To evaluate the clinical significance of alveolar dead space fraction （ADSF） in diagnosis and treatment of pulmonary thromboembolism （PTE）.【Methods】 A prospective study was conducted in 352 consecutive patients suspected of pulmonary thromboembolism from July 2004 to March 2007.The diagnosis of PTE was based on the results of clinical possibility,ultrasound,CTPA and Lung scintigraphy.ADSF was calculated by PaCO2 and PETCO2.【Results】 PTE was confirmed in 39 patients.ADSF of the PTE patients was significantly higher than that of the non-PTE patients [（0.228＋0.100） vs （0.120＋0.030）,P 0.05）].The diagnosis sensitivity,specificity,positive predictive value （LR＋） and negative predictive value （LR-） of ADSF for PTE were 71.8%,71.8%,17.95 and 2.94 respectively.The ADSF after treatment （0.09±0.04） decreased compared with that before treatment （0.280± 0.110） in the fully reperfused patients （ pared ttest,P 0.05）.【Conclusion】 ADSF is helpful in diagnosing PTE and saving examination costs.

关 键 词：肺栓塞 肺泡死腔分数 诊断 监测 

分 类 号：R563.5[医药卫生—呼吸系统]