Takayama Y, Iwasaka T, Sugiura T, Sumimoto T, Takeuchi M, Taniguchi H, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Jpn Circ J. 1991 Feb;55(2):125-32. doi: 10.1253/jcj.55.125.
To evaluate the clinical characteristic of pulmonary gas exchange in patients with low pulmonary capillary wedge pressure (PCW less than 18 mmHg) in the early phase of acute myocardial infarction, we investigated 48 patients admitted within 24h from the onset of chest pain. The alveolar-arterial oxygen tension difference (AaDO2) and arterial blood gas parameters were obtained while breathing room air on admission. The disturbance of pulmonary gas exchange, as revealed by the high value of AaDO2, existed without left ventricular dysfunction, and AaDO2 had no significant relationship with any of the hemodynamic parameters including the difference between plasma colloid osmotic pressure and PCW. Multiple regression analysis was performed using 9 variables related to pulmonary gas exchange, to identify those which were important. As a result, QRS score (p less than 0.01) and age (p less than 0.05) were identified as significant variables related to AaDO2. Thus, the disturbance of pulmonary gas exchange in patients with low PCW was caused by mechanisms other than left ventricular failure which may reflect the extent of ischemic myocardium.
为评估急性心肌梗死早期肺毛细血管楔压较低（肺毛细血管楔压小于18 mmHg）患者的肺气体交换临床特征，我们调查了胸痛发作后24小时内入院的48例患者。入院时在呼吸室内空气的情况下获取肺泡-动脉血氧分压差（AaDO2）和动脉血气参数。AaDO2值升高所显示的肺气体交换障碍在无左心室功能障碍的情况下存在，且AaDO2与任何血流动力学参数均无显著关系，包括血浆胶体渗透压与肺毛细血管楔压之间的差值。使用与肺气体交换相关的9个变量进行多元回归分析，以确定其中重要的变量。结果，QRS评分（p小于0.01）和年龄（p小于0.05）被确定为与AaDO2相关的显著变量。因此，肺毛细血管楔压较低患者的肺气体交换障碍是由左心室衰竭以外的机制引起的，这可能反映了缺血心肌的范围。
