Cherniack R M, Cuddy T E
Can Med Assoc J. 1969 Oct 18;101(8):84-6 passim.
Arterial blood gases and pH were assessed in 115 patients who had suffered a myocardial infarction, with or without complicating cardiogenic shock or cardiac standstill. In 11 of the 78 uncomplicated cases and in 16 of the 37 complicated cases, the arterial O(2) tension was much lower than would be expected on the basis of a three-fold drop in cardiac output, indicating considerable right to left shunting. The death rate in the patients with uncomplicated myocardial infarction was 32% and that of the complicated cases 65%. In both groups it was greatest when the arterial pH was low, indicating that correction of the acidosis is essential. In many instances administration of 100% oxygen is inadequate to restore the oxygen tension to normal levels, and controlled ventilation may be necessary to maintain adequate alveolar ventilation. The findings indicate the necessity for repeated assessment of the arterial blood gas tensions and pH in any patient who has suffered a myocardial infarction. If the management of such patients is designed to provide adequate oxygenation, to maintain adequate alveolar ventilation and to correct the acid-base disturbances, the patient may be tided over the stage of "cardiac pump failure".
对115例心肌梗死患者进行了动脉血气和pH值评估，这些患者伴有或不伴有并发的心源性休克或心脏停搏。在78例无并发症的病例中，有11例，在37例有并发症的病例中，有16例，动脉血氧分压远低于根据心输出量下降三倍所预期的水平，表明存在大量右向左分流。无并发症心肌梗死患者的死亡率为32%，有并发症患者的死亡率为65%。在两组中，当动脉pH值较低时死亡率最高，这表明纠正酸中毒至关重要。在许多情况下，给予100%的氧气不足以将氧分压恢复到正常水平，可能需要控制通气以维持足够的肺泡通气。这些发现表明，对于任何心肌梗死患者，都有必要反复评估动脉血气张力和pH值。如果对这类患者的治疗旨在提供充足的氧合、维持足够的肺泡通气并纠正酸碱紊乱，患者可能会度过“心脏泵衰竭”阶段。
