高危急性肺血栓栓塞症患者控制性机械通气下的高碳酸血症研究  

Hypercapnia under controlled mechanical ventilation in patients with high-risk acute pulmonary thromboembolism

作　　者：张婷[1] 隗思媛 杨嘉年 李宜瑶 薛培君 彭敏[1] 杨婧[3] 徐军[3] 施举红[1] Zhang Ting;Kui Siyuan;Yang Jianian;Li Yiyao;Xue Peijun;Peng Min;Yang Jing;Xu Jun;Shi Juhong(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100730,China;Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Emergency Medicine,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科,北京100730 [2]中国医学科学院北京协和医学院,北京100730 [3]中国医学科学院北京协和医学院北京协和医院急诊医学科,北京100730

出　　处：《中华结核和呼吸杂志》2023年第5期454-459,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-C-017)。

摘　　要：目的评价高危肺血栓栓塞症患者在机械通气下的动脉血二氧化碳分压(PaCO_(2))变化。方法回顾性分析2012年1月1日至2022年5月1日北京协和医院行静脉溶栓治疗的高危肺栓塞患者49例,其中男19例,女30例,年龄(57.8±14.5)岁。根据是否行有创机械通气分为机械通气组22例及自主呼吸组27例,比较两组患者自主呼吸状态下PaCO_(2)水平,比较机械通气组患者插管前、后及溶栓后PaCO_(2)变化,比较两组患者的14 d全因病死率。结果两组患者插管前PaCO_(2)均低于正常,差异无统计学意义。溶栓后两组患者PaCO_(2)均恢复至正常范围。机械通气组患者插管后11~147 min出现PaCO_(2)升高,溶栓后PaCO_(2)基本恢复正常,插管前、后及溶栓前、后PaCO_(2)差异有统计学意义。机械通气组患者14 d病死率为54.5%(12/22),而自主呼吸组患者全部存活。结论机械控制通气情况下,急性高危肺栓塞患者可表现为高碳酸血症,溶栓治疗成功后PaCO_(2)恢复正常。对于机械通气患者,若出现突发低氧血症伴高碳酸血症,应警惕高危肺栓塞的可能性。Objective To evaluate the variation of arterial partial pressure of carbon dioxide(PaCO_(2))in patients with high-risk pulmonary embolism under mechanical ventilation.Methods We retrospectively analyzed the cases of high-risk pulmonary embolism who underwent intravenous thrombolysis in Peking Union Medical College Hospital from January 1,2012,to May 1,2022.The enrolled patients were divided into a mechanical-ventilated group and an active-breathing group according to whether they received invasive mechanical ventilation or not.The level of PaCO_(2) under active breathing between the two groups,the changes in PaCO_(2) before intubation,after intubation and after thrombolysis in the mechanical-ventilated group were compared.The 14-day all-cause mortality of the two groups was calculated and compared.Results A total of 49 patients with high-risk pulmonary embolism were enrolled,including 22 patients in the mechanical-ventilated group and 27 patients in the active-breathing group.Before intubation,PaCO_(2) in both groups was lower than normal without statistically significant difference between the two groups.After effective thrombolysis therapy,PaCO_(2) in both groups recovered to the normal range.In the mechanical-ventilated group,PaCO_(2) significantly increased 11-147 min after intubation and returned to the normal range after thrombolysis therapy.The 14-day mortality in the mechanical-ventilated group was 54.5%,while all patients in the active-breathing group survived.Conclusions Under mechanical controlled ventilation,patients with high-risk pulmonary embolism could represent hypercapnia which resolved after effective thrombolytic therapy.In mechanical ventilated patients with sudden-onset hypoxemia and hypercapnia,the possibility of high-risk pulmonary embolism should be considered.

关 键 词：肺栓塞 高危 高碳酸血症 机械通气 

分 类 号：R563.5[医药卫生—呼吸系统]