评估肺泡-动脉氧梯度作为妊娠合并肺栓塞的筛查试验。
Assessment of the alveolar-arterial oxygen gradient as a screening test for pulmonary embolism in pregnancy.
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL 33606, USA.
出版信息
Am J Obstet Gynecol. 2010 Oct;203(4):373.e1-4. doi: 10.1016/j.ajog.2010.04.049. Epub 2010 Jun 15.
OBJECTIVE
The objective of the study was to determine whether the alveolar-arterial (A-a) oxygen gradient is an adequate screening test for pulmonary embolism (PE) in pregnancy and postpartum.
STUDY DESIGN
A chart review was performed at Tampa General Hospital. Patients who had a workup for a PE consisting of a computed tomography pulmonary angiogram and an arterial blood gas from 2002 to 2009 were included in the analysis. Sensitivity, specificity, and negative and positive predictive values were calculated. Additionally, common clinical signs and symptoms were assessed for their ability to accurately predict PE.
RESULTS
Of 102 patients, there were 13 PEs (2 antepartum and 11 postpartum). The best sensitivity, specificity, and negative and positive predictive values for A-a gradients were 76.9%, 20.2%, 80.0%, and 11.5%, respectively.
CONCLUSION
The A-a gradient is a poor screening test for PE in pregnancy and postpartum. Suspicion of PE should prompt early imaging studies to rapidly make the diagnosis and begin treatment.
目的
本研究旨在确定肺泡-动脉（A-a）氧梯度是否可作为妊娠期和产后肺栓塞（PE）的有效筛查试验。
研究设计
对坦帕总医院的病历进行了回顾性分析。纳入了 2002 年至 2009 年期间因疑似肺栓塞而行计算机断层肺动脉造影和动脉血气检查的患者。计算了灵敏度、特异性、阴性预测值和阳性预测值。此外，还评估了常见的临床体征和症状，以评估其准确预测 PE 的能力。
结果
在 102 例患者中，有 13 例 PE（2 例产前，11 例产后）。A-a 梯度的最佳灵敏度、特异性、阴性预测值和阳性预测值分别为 76.9%、20.2%、80.0%和 11.5%。
结论
A-a 梯度是妊娠期和产后 PE 的一种较差的筛查试验。对 PE 的怀疑应促使早期进行影像学检查以快速做出诊断并开始治疗。
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