血气分析和肺功能测定在肝肺综合征诊断中的意义

目的　探讨血气分析与肺功能测定在肝肺综合征(HPS)临床诊断中的价值 .方法　选择肝炎后肝硬化伴有HPS(2 3例 )和无 HPS肝硬化患者 (2 5例 ) ,分别进行血气分析和肺功能测定 .结果　 HPS患者呼吸困难、紫绀和杵状指发生率依次为 10 0 %、5 2 %和 6 1% ,而无 HPS的肝硬化患者未发现上述症状 ,同时发现 HPS组蜘蛛痣发生率 (78% )显著高于无 HPS组 (32 % ,P<0 .0 1) .血气分析结果表明 ,HPS组动脉血氧饱和度 (Sa O2 )、血氧分压 (Pa O2 )和 CO2 分压 (Pa-CO2 )均显著低于无 HPS肝硬化组 (P值均 <0 .0 1) ,同时动脉血 p H却显著增高 (P<0 .0 1) .肺功能测定结果显示 ,虽然HPS患者限制性通气功能障碍发生率 (17% )与肝硬化组(2 0 .0 % )比较无显著性差异 (P>0 .0 5 ) ,其肺 CO弥散量(DLCO)却显著低于肝硬化组 (P <0 .0 1) .在吸入空气或10 0 % O2 条件下 ,肺泡 -动脉血氧分压差 (PA- a O2 )和吸入纯氧时的肺内动 -静脉分流量 (QS/ QT)均显著高于肝硬化组 (P<0 .0 1) .结论　 1HPS患者肺弥散功能障碍和肺内静 -动脉分流现象可能是其低氧血症发生的病理基础 ;2血气分析与肺功能测定是 HPS诊断简单、易行地诊断参考指标

Significance of pulmonary function and blood gas analysis for diagnosis of hepatopulmonary syndrome

AIM To evaluate the values of pulmonary function assay and blood gas analysis for the diagnosis of hepatopulmonary syndrome (HPS). METHODS Pulmonary function assay and blood gas analysis were performed in cirrhotic patients with HPS (HPS, 23 cases) and without HPS (HC, 25 cases). RESULTS Such clinical manifestations associated with HPS as dyspnea (100%), cyanosis (52%)and clubbing of fingers (61%) were found in the cirrhotic patients with HPS, but not in HC. The incidence (78%) of spider nevus with HPS was significantly higher than that in HC group (32%, P <0.01). Arterial blood oxygen saturation (SaO 2), partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2) and diffusion capacity for carbon monoxide of lungs (DL CO ) were lower in HPS group ( P <0.01), but pH of arterial blood was higher ( P <0.01). Though no significantly different rate of restrictive ventilatory disorder was found comparing HPS (17%) with HC (20%, P >0.05), alveolar arterial oxygen tension volume (P A a O 2) under inspired gas with air or 100% oxygen and intropulmonary shunting of blood (Q S/Q T) with 100% oxygen was lower in patients with HPS ( P <0.01). CONCLUSION Diffusion dysfunction and intropulmonary shunting might be some important pathologic factors of hyoxemia. Pulmonary function assay and blood gas analysis can be used in the diagnosis of HPS.