高原地区慢性肺心病急性加重期危重患者脑脊液酸碱失衡与肺性脑病的关系  

Relationship between acid - base imbalance of cerebrospinal fl uid in chronic cor pulmonale at high altitude

作　　者：杨生岳[1] 冯恩志[1] 沈君礼[1] 高玲[1] 张瑛[1] 赵丽红[1] 吴雪梅[1] 

机构地区：[1]解放军第四医院呼吸内科,青海西宁810014

出　　处：《西北国防医学杂志》2005年第2期84-86,共3页Medical Journal of National Defending Forces in Northwest China

基　　金：全军医药卫生科研基金资助项目 (0 1MD0 14)

摘　　要：目的:探讨高原地区慢性肺心病急性加重期危重患者脑脊液(CSF)酸碱失衡与肺性脑病的关系及CSF酸碱调节机制。方法:对5 4例高原地区肺心病危重患者测定了动脉血和CSF的主要酸碱变量并进行对照分析。结果:①慢性呼酸时,动脉血pH多数降低,而CSFpH相对保持正常;②慢性呼酸并代碱时,动脉血pH可偏碱、正常或偏酸,而CSFpH相对正常;③慢性呼酸并代酸时,动脉血pH和CSFpH均显著下降;④如果CSF偏酸(pH7.2 9) ,患者表现为中枢神经系统(CNS )抑制症状。如果CSF偏碱(pH >7.37) ,患者表现为CNS兴奋症状,如果CSF严重偏酸(pH <7.2 3)或偏碱(pH >7.39) ,患者常发生昏迷;⑤各型酸碱失衡时,PaCO2 与CSFPCO2 、CSFPCO2 与CSF的HCO3 -均显著正相关(P均<0 .0 1)。结论:高原地区危重肺心病患者酸碱失衡时,CSF代偿能力较血液强,CSF的PCO2 在CSF酸碱调节中有重要作用,CSF酸碱失衡是肺性脑病的主要因素。Objective: To study the relationship b etween acid- base imbalance of cerebrospinal fluid ( CSF) and pulmonary encephalopathy in chronic cor pulmona le at high altitude(HACCP). Methods: The acid - base variables were dynamically observed in the arterial blood and CSF in 54 patients with HACCP. Results:① In the chronic respiratory acidosis,arterial blood pH was decreased, while CSF pH might keep normal.② In case of chronic respiratory acidosis with metabolic alk alosis,arterial blood pH might be alkaline,normal or acidic, while CSF pH might k eep relatively normal .③ In case of chronic respiratory acidosis with metabolic acidosis,both arterial blood pH and CSF pH were decreased. ④ If CSF was acidic ,the patients often had inhibitory symptoms of central nervous system(CNS).If CSF was alkaline ,the patients often had excitatory sympotoms of CNS. If CSF was seriously acidic or alkaline ,the patients often had coma.⑤There were sign ificant(P<0.01)correlation between CSF PCO 2 and PaCO 2,between CSF PCO 2 and CSF HCO 3- in all kinds of acid - base imbalance. Conclus ion: The results suggest that the ability of compensation of CSF is stronger than blood in acid - base disorders,and the acid - base imbalance of CSF is closely related to pulmonary encephalopathy in HACCP. The changes of CSF PCO 2 plays an important role in regulation of CSF acid- base balance .

关 键 词：肺疾病 阻塞性 肺心病 脑脊液 酸碱失衡 高海拔 

分 类 号：R541.5[医药卫生—心血管疾病]