慢性阻塞性肺病患者氧动力学变化及意义  

Changes of oxygen dynamics and its clinical importance in patients with chronic obstructive pulmonary disease:a 20 years' follow-up study

作　　者：张德明[1] 邹霞英[1] 辛达临[1] 邓青南[1] 曹淑芳[1] 

机构地区：[1]广州军区广州总医院老年呼吸内科,广州510010

出　　处：《第三军医大学学报》2007年第19期1902-1905,共4页Journal of Third Military Medical University

摘　　要：目的观察慢性阻塞性肺病(COPD)不同病情下氧动力学的变化,探讨其临床意义。方法对166例COPD患者进行20年跟踪随访,并运用右心漂浮导管结合血气分析,检测其血流与氧动力学的变化,对其中COPD和并发肺动脉高压(PH)、COPD和并发呼吸衰竭、COPD死亡和生存、COPD急性和缓解期进行对比研究,并对40例COPD并PH用消心痛进行干预。结果116例死亡,总病死率69.9%。单纯COPD、COPD稳定期、COPD存活者平均肺动脉压(mPAP)、心脏指数(CI)、总肺血管阻力(TPR)、氧供(DO2)尚保持在相对正常水平,氧耗(VO2)及氧摄取率(O2-ER)呈低水平;COPD并PH、呼衰、COPD急性期及死亡者首诊时的CI、DO2、VO2、O2-ER显著低于单纯COPD、COPD稳定期、COPD存活者,而mPAP、TPR显著增高(P<0.05,P<0.01);消心痛干预后CI、DO2、O2-ER显著上升,mPAP、TPR显著降低(P<0.05,P<0.01)。结论单纯COPD、COPD稳定期、COPD存活者,呈现低氧性非氧供依赖;COPD如急性加重或并发PH、呼衰、或死亡者,出现病理性氧供依赖;消心痛干预可增加氧供;氧供与氧耗严重降低可能是COPD死亡的危险因素。Objective To observe the changes of oxygen dynamics in patients with chronic obstructive pulmonary disease （COPD） and analyze its clinical importance. Methods The Swan-Gans catheters combined with arterial blood gas analysis were used to measure the parameters of blood and oxygen dynamics in 166 patients suffering from COPD during the period of 1977 - 1984. Those complicated pulmonary hypertension （PH） or respiratory failure （RF）, during the exacerbation or remission period, and the dead or the survived were comparatively studied within 20 years of follow-up （from 1984 to 2004）. Results Totally 116 out of 166 patients died with death rate of 69.9%. The mean pulmonary arterial pressure （mPAP）, cardiac index （CI）, total pulmonary vascular resistance （TPR）, oxygen delivery （DO2 ） were within normal ranges, and the oxygen consumption（VO2） and oxygen uptake rate（O2-ER） kept at relatively low levels in patients with simple COPD or in a stable period or still alive ; whereas in patients with COPD concurrent PH, RF, or in an exacerbation period or died, CI, DO2, VO2,O2-ER were significantly lowered and mPAP and TPR were significantly increased （P 〈 0.05 or 0.01 ）. After isoket intervention, the CI, DO2, and O2-ER in patients with COPD associated with PH were significantly increased and the mPAP, TPR decreased. Conclusion Patients suffering from COPD without PH, RF or in a stable period or still alive have a low level of balance for oxygen delivery and demand, and maintain a non-oxygen dependent status. When COPD exacerbated or associated with PH or RF, or patients died, this balance will be disturbed and patients are in oxygen-depended status. Vasodilators such as isoket can increase oxygen delivery. Extreme diminishment of oxygen supply and consumption are probably the dangerous factors responsible for the death of COPD.

关 键 词：肺疾病 慢性阻塞性 氧供给 氧消耗 

分 类 号：R446.11[医药卫生—诊断学] R563.9[医药卫生—临床医学]