每日一题_2023.06.26

A 74-year-old retired shipyard laborer with a 45-pack-year smoking history and previous work in sandblasting and fiberglass operations presents with increasing shortness of breath and peripheral edema. On physical examination he is a thin, cyanotic man in moderate pulmonary distress. His chest shows an increased anteroposterior diameter, and the breath sounds are faint with a prolonged expiration. The liver edge is 3 cm below the right costal margin. There is no digital clubbing, but marked peripheral edema is present. Arte- rial blood gas analysis reveals a partial oxygen pressure of 43 mm Hg, a partial carbon dioxide pressure of 22 mm Hg, and a pH of 7.51. Which set of laboratory parameters is most likely to be found?

一名74岁的退休船厂工人，有45包/年的吸烟史，以前从事喷砂和玻璃纤维作业，出现呼吸急促和周围水肿。体格检查显示，他瘦弱，面色发紫，有中度肺窘迫。他的胸片显示前后径增大，呼吸音微弱，呼气延长。肝缘在右肋缘下3 cm处。没有杵状指，但有明显的外周水肿。动脉血气分析显示氧分压为43 mmhg，二氧化碳分压为22 mmhg, pH为7.51。哪一组实验室参数最有可能被发现?

(A) A

(B) B

(C) C

(D) D

(E) E

答案解析：

前后径增大、呼气延长提示患者患有慢性阻塞性肺疾病(COPD)。FEV1、用力肺活量(FVC)和FEV1∶FVC比值的降低是气道阻塞的标志。肺总量(TLC)增加是由于肺过度充气，继发于呼气流速受限。

正确答案：B