高原慢性肺心病急性加重期周围性水肿发生机理的研究  

Pathogensis of Peripheral Edema in Acute Exacerbation Phase of Chronic Cor Pulmonale at High Altitude

作　　者：杨生岳[1] 冯恩志[1] 索玉梅[1] 赵宁伟[1] 

机构地区：[1]解放军第四医院

出　　处：《西北国防医学杂志》1998年第4期14-16,共3页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的：探讨高原慢性肺心病急性加重期周围性水肿的发生机理。方法：对高原（２２６０～３２００ｍ）肺心病急性加重期并发重度周围性水肿（Ａ组，３３例），轻、中度周围性水肿（Ｂ组，４９例）患者作了无创血流动力学、血气、血清蛋白、肾功能和血钠测定，并与７５例病情相似而无水肿的患者（Ｃ组）对比。结果：Ａ组Ｑｂ间期、Ｑｂ／ｂｙ比值、ｍＰＡＰ、ＰＶＲ、ＰａＣＯ２、ＢＵＮ、Ｃｒ及Ｎａ＋明显高于、ｂｙ间期、ＣＩ、ＳＩ、ＰａＯ２明显低于Ｂ组（Ｐ均＜０．０１）；Ｂ组除ＰａＯ２明显低于、ＰａＣＯ２和Ｎａ＋明显高于Ｃ组（Ｐ均＜０．０１）外，余各项指标两组间均无明显差异。结论：高原肺心病重度水肿的发生除与右心功能不全有关外，还与严重低氧血症和高碳酸血症引起的钠水潴留有关。轻、中度水肿的发生与右心功能关系不明显，可能与低氧血症和高碳酸血症引起的钠水潴留有关。Purpose: To investigate the pathogensis of peripheral edema in acute exacerbation phase of chronic cor pulmonale(CCP) induced by chronic obstructive pulmonary diseases(COPD) at high altitude. Methods: The nontraumatic hemodynamics, arterial blood gases, serum protein, renal function and serum sodium were measured in 82 CCP patients with periperal edema and 75 CCP patients without periperal edema(group C) at high altitude(2 260～3 200 m). According to degree of edema. the group of 82 cases was divided into two groups: severe group(group A, 33 cases) and mild moderate group(group B, 49 cases). Results: The values of Q b interval, Q b/b y rate, mPAP, PAP, PVR,PaCO 2, BUN, Cr and Serum Na + in group A were significantly higher than those in group B( P <0.01). The values of b y interval, CI, SI and PaO 2 in group A were significantly lower than those in group B( P <0.01). The values of PaCO 2 and serum Na + in group B were significantly higher than those in group C( P <0.01). The value of PaO 2 was significantly lower than that in group C( P <0.01). Conclusion: The occurrence of severe edema in CCP patients at high altitude is related not only to right heart dysfunction as well as to retention of sodium and water induced by severe hypoxemia and hypercapnia. The occurrence of mildmoderate edema is not obviously related to right heart dysfunction and may be related to retention of sodium and water induced by hypoxemia and hypercapnia.

关 键 词：慢性阻塞性肺疾病 肺心病 水肿 高原 

分 类 号：R541.5[医药卫生—心血管疾病]