重症肺炎患儿肺泡动脉氧分压差及D-二聚体与肺功能的相关性

摘要

目的 探讨重症肺炎患儿的肺泡动脉氧分压差(PA-aO2)及血浆中D-二聚体(DD)水平与肺功能的关系.方法 选取2011年1月～2016年12月邢台市第三医院收治的95例重症肺炎患儿作为观察组,另选取同时期50例健康体检小儿为对照组,监测健康小儿体检当天,患儿急性期及出院后3、6个月的第1秒时用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰流速(PEF)及最大呼气中段流量(MMF)及PA-aO2,测定血浆中DD水平,对比分析PA-aO2、DD与肺功能相关指标变化的相关性.结果 重症患儿的肺功能各指标(FEV1、FVC、PEF、MMF)均显著低于对照组(P＜0.01),PA-aO2及血浆中DD水平显著高于对照组(P＜0.01);出院后3、6个月,重症肺炎患儿FEV1、FVC、PEF、MMF较急性期升高,PA-aO2及血浆中DD较急性期降低,各指标与急性期比较,差异均有统计学意义(P＜0.01);PA-aO2与肺功能各指标(FVC、FEV1、PEF、MMF)均呈负相关(r=-0.459、-0.476、-0.475、-0.689,P＜ 0.05),血浆中DD水平与肺功能各指标(FEV1、FVC、PEF、MMF)均呈负相关(r=-0.481、-0.384、-0.463、-0.693,P＜ 0.05).结论 重症肺炎患儿PA-aO2及DD与肺功能损害程度具有相关性,在重症肺炎患儿的病情评估、治疗及预后中具有重要价值.%Objective To investigate the relationship between alveolar arterial oxygen partial pressure (PA-aO2) or plasma D-dimer (DD) and pulmonary function in children with severe pneumonia.Methods From January 2011 to December 2016,in Third Hospital of Xingtai,95 children with severe pneumonia were selected as the observation group,and 50 healthy children were selected as control group at the same period.The first second forced expiratory volume (FEV1),forced vital capacity (FVC),peak expiratory flow (PEF) and maximal midexpiratory flow (MMF),PA-aO2 and plasma DD in health children and children with severe pneumonia in acute phase and 3,6 months after discharge were monitored,and the correlation between PA-aO2,DD and the changes of pulmonary function indexes were analyzed.Results The pulmonary function indexes (FEV1,FVC,PEF,MMF) in children with severe pneumonia were significantly lower than the control group,the differences were statistically significant (P ＜ 0.01),and the levels of PA-aO2 and DD was significantly higher than the control group,the differences were statistically significant (P ＜ 0.01).The FEV1,FVC,PEF and MMF in children at 3,6 months after discharge were higher than those in the acute phase,the differences were statistically significant (P ＜ 0.01),PA-aO2 and plasma DD were lower than those in the acute stage,the differences were statistically significant (P ＜ 0.01).The PA-aO2 in children with severe pneumonia showed a negatively correlation with FVC,FEV1,PEF and MMF (r =-0.459,-0.476,-0.475,-0.689,P ＜ 0.05),and the DD level also showed a negatively correlation with FVC,FEV1,PEF and MMF (r =-0.481,-0.384,-0.463,-0.693,P ＜ 0.05).Conclusion PA-aO2 and DD in children with severe pneumonia has significant correlation with the degree of pulmonary function impairment.It has important value in the assessment,treatment and prognosis of children with severe pneumonia.