CAJ | 학술논문

目的：探讨心功能不全与老年肺炎及肺癌伴胸腔积液的相关性。方法采用前瞻性对照研究，57例入选病例按病因诊断分为2组：肺炎合并胸腔积液组30例（肺炎组），肺癌合并感染伴胸腔积液组27例（肺癌组）。2组患者在对症治疗的基础上采用相同原则抗感染和强心、利尿的治疗措施。所有患者入院后依据NYHA分级标准评定心功能（Cardiac function classification，CFC）；并于入院后第1d和治疗后7 d，为患者做胸部CT检查，超声测定心脏左心室舒张末内径( LVEDD)和左心室射血分数( LVEF)，并同时检测血浆B型钠尿肽（BNP）浓度。结果肺炎组心衰的患病率（86.7%）明显高于肺癌组（14.8%）,P＜0.01。治疗前肺炎组LVEF低于肺癌组（43.58±4.16比59.11±6.35，P＜0.01）；LVEDD高于肺癌组（62.43±7.94比48.18±5.12，P＜0.01）；BNP明显高于肺癌组（582.67±126.53比146.27±43.77），差异有统计学意义,P＜0.01。治疗7 d后,肺炎组LVEF增加、LVEDD减小和BNP下降与治疗前比较，差异有统计学意义,P＜0.01；而肺癌组治疗前后LVEF、LVEDD和BNP均无明显变化,P＞0.05。肺炎组胸腔积液的治疗效果[70.0%(21/30)的患者完全吸收，16.7%(5/30)部分吸收，13.3%(4/30)无吸收]明显优于肺癌组[18.5%(5/27)部分吸收，81.5%(22/27)无吸收，P＜0.05]。结果表明，肺炎组的治疗效果与BNP下降、LVEDD减小和LVEF增加相一致。结论心功能不全在老年肺炎伴胸腔积液者有很高的发生率，动态监测患者BNP水平、LVEF和LVEDD的变化，对指导心功能不全相关性胸腔积液的诊断和治疗有重要的临床意义。
목적：탐토심공능불전여노년폐염급폐암반흉강적액적상관성。방법채용전첨성대조연구，57례입선병례안병인진단분위2조：폐염합병흉강적액조30례（폐염조），폐암합병감염반흉강적액조27례（폐암조）。2조환자재대증치료적기출상채용상동원칙항감염화강심、이뇨적치료조시。소유환자입원후의거NYHA분급표준평정심공능（Cardiac function classification，CFC）；병우입원후제1d화치료후7 d，위환자주흉부CT검사，초성측정심장좌심실서장말내경( LVEDD)화좌심실사혈분수( LVEF)，병동시검측혈장B형납뇨태（BNP）농도。결과폐염조심쇠적환병솔（86.7%）명현고우폐암조（14.8%）,P＜0.01。치료전폐염조LVEF저우폐암조（43.58±4.16비59.11±6.35，P＜0.01）；LVEDD고우폐암조（62.43±7.94비48.18±5.12，P＜0.01）；BNP명현고우폐암조（582.67±126.53비146.27±43.77），차이유통계학의의,P＜0.01。치료7 d후,폐염조LVEF증가、LVEDD감소화BNP하강여치료전비교，차이유통계학의의,P＜0.01；이폐암조치료전후LVEF、LVEDD화BNP균무명현변화,P＞0.05。폐염조흉강적액적치료효과[70.0%(21/30)적환자완전흡수，16.7%(5/30)부분흡수，13.3%(4/30)무흡수]명현우우폐암조[18.5%(5/27)부분흡수，81.5%(22/27)무흡수，P＜0.05]。결과표명，폐염조적치료효과여BNP하강、LVEDD감소화LVEF증가상일치。결론심공능불전재노년폐염반흉강적액자유흔고적발생솔，동태감측환자BNP수평、LVEF화LVEDD적변화，대지도심공능불전상관성흉강적액적진단화치료유중요적림상의의。
Objective To observe the correlation between cardiac insufficiency and pleural effusion in elderly who were suffering from pneumonia or lung cancer. Methods A prospective study was carried out to investigate 57 emergently hospitalized patients with pleural effusion, and according to the etiology, they were divided into two groups:a senile pneumonia group (30 cases) and a lung cancer group (27 cases). The same therapeutic measures were taken in the two groups, such as, anti-infection, enhancement of cardiac function, dieresis, and limitation of the amount of liquid intake. After admission, every patient’s cardiac function was determined according to the gradation of the New York Heart Association (NYHA). Respectively, all the patients took the CT scan of the chest before the treatment and on the 7th day after treatment, and at the same time, left ventricular end-diastolic diameter (LVEDD), left ventricular ejection Fraction (LVEF) and plasma concentrations of B-type natriuretic peptide (BNP) were detected. Results 1. The incidence of congestive heart failure (CHF) in pneumonia group was significantly higher than that in lung cancer group (86.7%vs. 14.8%, P<0.01). 2. Before treatment, LVEF in pneumonia group was lower than that in group of lung cancer (43.58±4.16 vs.59.11±6.35, P<0.01), LVEDD and BNP were significantly higher than that in lung cancer group (62.43±7.94 vs.48.18± 5.12; 582.67 ± 126.53 vs.146.27 ± 43.77, respectively, P<0.01). Compared that with before treatment, after treatment the BNP and LVEDD declined down and LVEF increased up in pneumonia group (P<0.01). Nevertheless, LVEDD or LVEF and BNP no vary in lung cancer group (P>0.05). 3. The therapeutic effect that pleural effusion was absorbed in pneumonia group〔%(cases)〕was much superior to that in lung cancer group〔completely 86.7%(21/30), partly 16.7%(5/30) and no 13.3%(4/30) vs. respectively 0(0/27),18.5%(5/27) and 81.5%(22/27), P<0.01〕. The results showed that the treatment effect was consistent with the decreased of BNP and increased of LVEF of in pneumonia group. Conclusion There is a high incidence of cardiac insufficiency in patients with senile pneumonia accompanied by pleural effusion. It is very important to monitored dynamically the concentration of plasma BNP and the change of LVEDD and LVEF for guiding the diagnosis and treatment of pleural effusion with cardiac insufficiency.