不同血红蛋白浓度对急性肺栓塞近期预后的影响  

Influence of different hemoglobin concentrations on short-term prognosis in patients with acute pulmonary embolism

作　　者：吕静[1] 魏庆民[1] 吕兰芳[1] 李怡霖[1] 庄红燕 

机构地区：[1]邢台市人民医院心内科,河北邢台054000 [2]邢台市中医院内科,河北邢台054000

出　　处：《岭南心血管病杂志》2017年第2期201-204,共4页South China Journal of Cardiovascular Diseases

基　　金：邢台市科技支撑计划(项目编号:20152C079)

摘　　要：目的评价不同血红蛋白浓度对急性肺栓塞近期患者预后的影响。方法选取急性肺动脉栓塞的患者204例进行回顾性分析,分为轻、中、重度贫血组3组共52例,非贫血组152例。比较4组患者发病因素差异及出现呼吸衰竭、右心衰竭、休克及30 d内死亡等不良事件发生率的差异。结果非贫血组与轻、中、重度贫血组患者的既往心、脑、肾、免疫系统等疾病病史、年龄、性别等基础资料分布均衡,差异无统计学意义(P>0.05)。4组肺泡动脉氧分压差[alveolar-arterial oxygen partial pressure difference,P(A-a)O_2]、动脉血氧分压(partial pressure of oxygen,PaO_2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_2、氨基末端脑钠肽前体(N-terminal pro-brainnatriuretic peptide,NT-pro BNP)、肌钙蛋白I(troponin I,TNI)、心型脂肪酸结合蛋白(heart-type fatty acid-bindingprotein,H-FABP)指标比较,差异均有统计学意义(P<0.05)。4组患者随着血红蛋白浓度降低,其PaO_2、PaCO_2呈逐渐降低趋势,P(A-a)O_2、NT-pro BNP、TNI、H-FABP呈逐渐升高趋势。非贫血组与轻、中、重度贫血组中呼吸衰竭、右心衰竭、休克及30 d内死亡发生率比较,差异均存在统计学意义(P<0.05),且呈逐渐上升趋势。结论血红蛋白浓度对于急性肺动脉栓塞患者判断近期预后有相应的临床应用价值,并且随着血红蛋白浓度的降低,临床不良事件发生率呈升高趋势,其低于正常常提示预后不良,是急性肺动脉栓塞患者近期病死率的危险因素。Objectives To evaluate the influence of different hemoglobin concentrations on short-term prognosis in patients with acute pulmonary embolism. Methods A total of 204 patients with acute pulmonary artery embolism conformed by 64 Slice multi-detector computed tomography （MDCT） were enrolled in this study. Patients were divided into two groups according to this criterion： anemia group （n=52） and non-anemia group （n=152）. Anemia group according to hemoglobin concentration was divided into three groups ： mild anemia group, moderate anemia group and severe anemia group. Incidences of respiratory failure, right heart failure, shock, death and other adverse events among the four groups were compared. Results There was no significant difference among the four groups about mean age, gender distribution, cardiac function, hypertension, diabetes, chronic obstruetive pulmonary disease, renal fimction and medications used （all P〉0.05）. With hemoglobin concentration decreased, partial pressure of oxygen （PaO2） , partial pressure of carbon dioxide （PaCO2） decreased gradually, alveolar-arterial oxygen partial pressure difference [P （A-a） O2], N-terminal pro-brain natriuretie peptide （NT-proBNP）, troponin I （TNI）, heart-type fatty acid-binding protein （H-FABP） showed a gradually increasing trend. Incidences of respiratory failure, right heart failure, shock and death significandy increased in anemia group compared with non-anemia group （P〈0.05） , and gradually increased. Conclusions Hemoglobin concentration is a useful clinical indicator for evaluating short-term prognosis of acute pulmonary artery embolism, with the decreasing of hemoglobin concentrations, clinical adverse event rates show an increasing trend. When hemoglobin concentration is lower than normal, it is a risk factor of short-term mortality rate in patients with acute pulmonary artery embolism.

关 键 词：急性肺栓塞 血红蛋白 近期预后 

分 类 号：R543.5[医药卫生—心血管疾病]