全身体积描记法和血气分析在经皮冠状动脉介入治疗的急性心肌梗死患者中的应用。

Whole-Body Plethysmography and Blood Gas Analysis in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

机构信息

Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen,

Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany.

出版信息

Respiration. 2019;97(1):24-33. doi: 10.1159/000491096. Epub 2018 Aug 15.

DOI:10.1159/000491096

PMID:30110686

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) often occur together. However, COPD is underdiagnosed among CHD patients.

OBJECTIVES

This study investigated the prevalence of COPD and relevant pulmonary function test (PFT) impairments in patients with acute myocardial infarction (AMI).

METHODS

Patients undergoing coronary angiography for AMI were prospectively included. Body plethysmography, lung diffusing capacity, blood gas analysis, and echocardiography were performed. The following patient subgroups were compared: with versus without COPD, ST elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI). The prevalence of PFT impairments was also recorded.

RESULTS

A total of 100 patients (51 with NSTEMI, 49 with STEMI) were included. Twenty patients had diagnosed COPD, of whom 15 were diagnosed for the first time; 80% of all COPD patients were not receiving COPD therapy. Patients with COPD had higher maximum creatine kinase (p = 0.008) and troponin T (p = 0.054) levels than those without COPD. Hypoxaemia was more common in COPD patients (lower oxygen saturation [p = 0.008] and partial pressure of oxygen [PaO2] [p = 0.005]). PaO2 was significantly lower in STEMI compared with NSTEMI (p = 0.017). Independent of a COPD diagnosis, 65 patients had relevant PFT impairments.

CONCLUSIONS

The high prevalence of undiagnosed COPD and relevant pulmonary function impairments in this cohort of patients with AMI, and the fact that pulmonary disease was untreated in the majority of COPD patients, highlight the importance of a general pulmonary workup of patients with AMI. Furthermore, patients with CHD should undergo screening for COPD, given the fact that COPD patients had larger infarction size.

摘要

背景

慢性阻塞性肺疾病（COPD）和冠心病（CHD）常同时发生。然而，在 CHD 患者中，COPD 的诊断不足。

目的

本研究旨在调查急性心肌梗死（AMI）患者中 COPD 的患病率和相关肺功能检查（PFT）损害。

方法

前瞻性纳入行冠状动脉造影检查的 AMI 患者。进行体描法、肺弥散量、血气分析和超声心动图检查。比较以下患者亚组：有或无 COPD、ST 段抬高型心肌梗死（STEMI）与非 ST 段抬高型心肌梗死（NSTEMI）。还记录了 PFT 损害的患病率。

结果

共纳入 100 例患者（51 例 NSTEMI，49 例 STEMI）。20 例患者确诊为 COPD，其中 15 例为首次诊断；所有 COPD 患者中有 80%未接受 COPD 治疗。与无 COPD 的患者相比，COPD 患者的肌酸激酶最大值（p = 0.008）和肌钙蛋白 T （p = 0.054）水平更高。COPD 患者更常见低氧血症（更低的氧饱和度 [p = 0.008] 和氧分压 [PaO2] [p = 0.005]）。与 NSTEMI 相比，STEMI 患者的 PaO2 显著降低（p = 0.017）。独立于 COPD 诊断，65 例患者存在相关的 PFT 损害。