慢性阻塞性肺疾病急性呼吸衰竭有创机械通气患者血气分析动态变化规律与预后的关系研究  

The Relations between Dynamic Changes in Blood Gas Analysis and Prognosis of Patients with Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease Requiring Invasive Mechanical Ventilation

作　　者：李飞[1] 李惠 郭彩霞[1] 

机构地区：[1]郑州人民医院呼吸一区,河南省郑州市450003 [2]汉口医院内三科

出　　处：《中国全科医学》2013年第10期1123-1127,共5页Chinese General Practice

摘　　要：目的了解慢性阻塞性肺疾病急性呼吸衰竭有创机械通气患者血气分析的动态变化特点,分析其与预后的关系。方法回顾性分析我院呼吸重症监护室(RICU)2008年5月—2009年12月收住院的83例慢性阻塞性肺疾病急性加重期呼吸衰竭有创机械通气患者每日动脉血二氧化碳分压(PaCO2)、pH、HCO3-,比较生存组(52例)与死亡组(31例)患者上述指标的变化差异;以距入住RICU的时间(以天数表示)及分组为固定效应,患者编号为随机效应进行多水平线性模型分析,探讨血气分析指标随住院时间变化的特征及与预后的关系。结果 (1)生存组观察期间pH均值为(7.45±0.09)、HCO3-为(25.3±4.4)mmol/L、PaCO2为(37.5±9.8)mm Hg;死亡组pH值为(7.39±0.11)、HCO3-为(22.8±7.2)mmol/L、PaCO2为(43.2±16.3)mm Hg;两组间比较差异均有统计学意义(P<0.05)。(2)除第8天外,两组在不同的时间pH值差异有统计学意义(P<0.05);第1～5天,两组pH均呈上升趋势;在最后3 d,生存组pH值超过7.45,水平相对稳定,无上升或下降趋势;而死亡组在最后3 d的pH值呈下降趋势,死亡之前pH值接近7.30。(3)在第4～8天,两组HCO3-差异无统计学意义(P>0.05);生存组HCO3-基本是平稳的,波动幅度较小,有8 d维持在24～26 mmol/L之间,表现较为稳定;而死亡组HCO3-呈逐渐上升的趋势,由第1天的明显低于参考下限到第9天的高于参考值上限。(4)除第1天和第9天,两组PaCO2在不同的时间差异均无统计学意义(P>0.05);插管后生存组PaCO2降低幅度大于死亡组,插管后的PaCO2低于死亡组,且以后一直比较稳定,在35～36 mm Hg,直到拔除气管插管后亦未见反跳;在插管后第6～9天,死亡组PaCO2呈逐渐上升的趋势,在第9 d达到最高。结论存活患者在机械通气后酸碱平衡基本保持稳定;而死亡患者后期却出现明显的酸中毒。pH值在入住RICU后随时间变化明显;PaCO2和HCO3-在患者死亡当天出现明显的变化。Objective To investigate the relations between dynamic changes in blood gas analysis and prognosis of pa- tients with acute respiratory failure （ARF） in chronic obstructive pulmonary disease （COPD） requiring invasive mechanical venti- lation （IMV） . Methods A total of 83 hospitalized patients with acute exacerbated COPD requiring IMV in respiratory intensive care unit （RICU） of our hospital between May 2008 and December 2009 were retrospectively analyzed. The changes of their daily arterial PaCO2, pH, and HCO3 - were compared between the survival group （n = 52 ） and the non - survival group （n = 31 ）. Multi -level linear model with time of stay at RICU （days） and group as fixed effects and patient number as random effect was used to analyze the blood gas changes with hospital stay and its relations with prognosis. Results Significant differences were ob- served between the survival group and the non - survival group in average pH value （7.45±0. 09） vs. （7.39±0. 11 ）, HCO3 - concentration （25.3±4.4） mmol/L vs. （22. 8±7. 2） mmol/L, and PaCO2 （37.5±9. 8） mm Hg vs. （43.2±16. 3） mm Hg （P 〈0. 05）. The pH values of the two groups were significantly different on each day except day 8 （P 〈0. 05）. Between day 1 and day 5, the pH value increased in both groups. During the last 3 days, pH value of the survival group stably set above 7.45, while the pH value of the non - survival group decreased and dropped to 7. 30 before death. Between day 4 and day 8, no signifi- cant difference was observed between the two groups in HCO3 - concentration （P 〉 0. 05）. HCO3 - concentration in the survival group was basically stable and remained between 24 - 26 annol/L for 8 days, while that of the non - survival group increased grad- ually from below the reference value on day 1 to above the reference value on day 9. Except for day 1 and day 9, no significant difference was observed in PaCO2 between the two groups （P 〉 0. 05 ）. PaCO2 of the survival group great

关 键 词：肺疾病 慢性阻塞性 呼吸重症监护室 机械通气 动脉血气分析 酸碱平衡 

分 类 号：R563[医药卫生—呼吸系统]