目的 評(píng)價(jià)肺泡死腔分?jǐn)?shù)( ADSF) 測定對(duì)急性肺栓塞病情評(píng)估的作用。方法 連續(xù)入選39 例急性肺栓塞患者進(jìn)行前瞻性研究, 根據(jù)栓塞面積將患者分為大范圍栓塞組( LPE) 和小范圍栓塞組( SPE) , 分別接受溶栓和抗凝治療或單純抗凝治療。30 d 后進(jìn)行CT 肺血管造影( CTPA) 或核素通氣/ 灌注( V / Q ) 顯像, 確定阻塞血管的再通程度。治療前和治療后30 d, 測定患者呼氣末CO2( PETCO2 ) 和動(dòng)脈血?dú)? 根據(jù)PETCO2 和PaCO2 計(jì)算ADSF。結(jié)果 39 例APE 患者中, 18 例( 46. 2% )為LPE 組,21 例( 53. 8% ) 為SPE 組。治療前LPE 組的ADSF 明顯高于SPE 組( 0. 34 ±0. 078 比0. 18 ±0. 027, P lt;0. 05) 。治療后30 d,21 例患者阻塞血管完全再通, 再通后ADSF較治療前明顯下降( 0. 09 ±0. 04 比0. 28 ±0. 11, P lt;0. 01) 。結(jié)論 床旁ADSF監(jiān)測能夠反映血栓范圍和再通情況, 有助于急性肺栓塞患者的病情評(píng)估。
引用本文： 韓偉,唐華平,郝萬明,孫文欣,李雙保. 肺泡死腔分?jǐn)?shù)對(duì)急性肺栓塞病情的評(píng)估價(jià)值. 中國呼吸與危重監(jiān)護(hù)雜志, 2010, 9(5): 520-522. doi: 復(fù)制
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| 5. | Rodger MA, Jones G, Rasuli P, et al. Steady-State End-Tidal Alveolar Dead Space Fraction and D-Dimer: Bedside Tests To Exclude Pulmonary Embolism. Chest, 2001, 120: 115-119. |
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- 1. 肇冬梅, 章志丹, 朱然, 等. 住院肺血栓栓塞癥患者32 年臨床流行病學(xué)分析. 中國呼吸與危重監(jiān)護(hù)雜志, 2006, 5: 345 -348.
- 2. Kline JA, Israel EG, Michelson EA, et al. Diagnostic accuracy of a bedside D-dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism: a multicenter study. JAMA,2001, 285 : 761-768.
- 3. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì). 肺血栓栓塞癥的診斷與治療指南( 草案) . 中華結(jié)核和呼吸雜志, 2001, 24: 259-264.
- 4. Kline J, Meek S, Boudrow D, et al. Use of the alveolar dead space fraction ( VD/ VT) and plasma D-dimers to exclude acute pulmonary embolism in ambulatory patients. Acad Emerg Med, 1997, 4 : 856 -863.
- 5. Rodger MA, Jones G, Rasuli P, et al. Steady-State End-Tidal Alveolar Dead Space Fraction and D-Dimer: Bedside Tests To Exclude Pulmonary Embolism. Chest, 2001, 120: 115-119.
- 6. Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002 , 346: 1281 -1286 .
- 7. Moreira MM, Terzi RG, Carvalho CH, et al. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism. Vasc Health Risk Manag, 2009 , 5: 9 -12 .