初探非高危急性肺血栓栓塞症合并低氧血症的适宜治疗  

The appropriate treatment for Acute Pulmonary Thromboembolism patients complicated with different degrees of Hypoxemia in not-high-risk group

作　　者：余倩[1] 黄支隆 张金兰 刘维佳[1] YU Qian;HUANG Zhilong;ZHANG Jinlan;LIU Weijia(Guizhou Provincial People’s Hospital,Respiratory&Critical care dept,Guizhou,Guiyang 550002,China)

机构地区：[1]贵州省人民医院呼吸与危重症医学科,贵州贵阳550002 [2]黔西南州人民医院呼吸与危重症医学科,贵州兴义562400

出　　处：《现代医学与健康研究电子杂志》2022年第6期104-107,共4页Modern Medicine and Health Research

摘　　要：目的探讨非高危组急性肺血栓栓塞症(APE)患者发生低氧血症与疾病严重程度的关系及合并不同程度低氧血症的适宜治疗手段。方法根据氧合指数将129例非高危组APE患者分为低氧血症组与非低氧血症组,并对合并低氧血症的APE患者,按治疗方法、氧合指数大小、危险分层方法分别进一步分组,回顾性分析各指标及治疗方法在不同分组中的统计学意义。结果合并低氧血症的APE患者氧合指数(PaO_(2)/FiO_(2))、D-二聚体(D-D)、脑钠肽(BNP)、肺栓塞严重指数(PESI)高于非低氧血症组。轻、中、重度低氧组中肺泡-动脉血氧分压差[P(A-a)O_(2)]、PESI、D-D、心肌肌钙蛋白I(cTnI)、BNP、C反应蛋白(CRP)随低氧血症程度的加重逐渐升高,动脉血二氧化碳分压(PaCO_(2))逐渐降低,各指标在重度与轻度低氧血症组间比较均有统计学意义(P<0.05)。P(A-a)O_(2)、PESI、D-D、cTnI、BNP、CRP随危险程度加重在低危组、中低危组、中高危组中逐渐升高,各指标在低危组与中高危组间比较均有统计学意义(P<0.05)。结论低氧血症与疾病的严重程度相关。不合并低氧血症的非高危组APE适宜抗凝治疗;PaO_(2)/FiO_(2)≤100 mmHg(1 mmHg=0.133 kPa)可能是非高危组APE溶栓治疗的指征;PaO_(2)/FiO_(2)≤200 mmHg的非高危组APE患者,需密切观察病情变化,做好补救溶栓治疗准备。Objective To investigate the relationship between hypoxemia and the severity of APE patients in not-high-risk group and the appropriate treatment for the APE patients with different degree of hypoxemia.Methods Based on PaO_(2)/FiO_(2),129 cases of APE in not-highrisk group were divided into hypoxemia group and non hypoxemia group.According to treatment methods,PaO_(2)/FiO_(2) and the risk stratification,the patients of APE complicated with hypoxemia in not-high-risk group were divided into different groups.The statistical significance of oxygen flow,PaO_(2)/FiO_(2),PaCO_(2),P(A-a)O_(2),cTnI,BNP,CRP,D-D,PESI and treatment methods in different groups was analyzed.Results Combined with non hypoxemia patients,P(A-a)O_(2),D-D,BNP and PESI in hypoxemia group were higher than those in the non hypoxemia group.P(A-a)O_(2),PESI,D-D,cTnI,BNP and CRP increased gradually in mild,moderate and severe hypoxemia group,but PaCO_(2) decreased gradually,and the above indexes between severe and mild hypoxemia group all had statistically significant differences(P<0.05).P(A-a)O_(2),PESI,D-D,cTnI,BNP and CRP increased gradually with the increase of the risk degree,each index had statistically significant between low risk group and intermediatehigh risk group(P<0.05)Conclusions APE patients with hypoxemia are related with the severity of the disease.APE in not-high-risk group without hypoxemia is suitable for anticoagulation therapy.PaO_(2)/FiO_(2)≤100 mmHg may be the index of thrombolytic therapy for APE of nothigh-risk group.The patients with PaO_(2)/FiO_(2)≤200 mmHg should be observed closely and should be prepared for remedial thrombolytic therapy.

关 键 词：非高危急性肺血栓栓塞症 低氧血症 氧合指数 溶栓指征 补救溶栓治疗 

分 类 号：R563.5[医药卫生—呼吸系统]