高原慢性肺原性心脏病患者吸气肌功能失调与高碳酸血症的关系  

Relationship of inspiratory muscle dysfunction and chronic hypercapnia in patients with chronic cor pulmonale at high altitude

作　　者：杨生岳[1,2] 冯恩志[1,2] 赵宁伟[1,2] 詹正嵩 索玉梅[1,2] 

机构地区：[1]解放军第四医院 [2]北京军事医学科学院

出　　处：《中国危重病急救医学》1998年第2期79-82,共4页Chinese Critical Care Medicine

摘　　要：目的：探讨高原肺心病患者吸气肌功能失调与高碳酸血症的关系。方法：测定４８例高原（海拔２２６０～３２００ｍ）慢性肺心病缓解期患者肺功能、血气、口腔最大吸气压（ＰＩｍａｘ）、最大跨膈压（Ｐｄｉ－ｍａｘ）和膈肌张力时间指数（ＴＴｄｉ），并与４２例当地同龄健康人对比。结果：（１）肺心病组ＰＩｍａｘ、Ｐｄｉｍａｘ明显低于健康组（Ｐ均＜０．０１），ＴＴｄｉ较健康组明显延长（Ｐ＜０．０１）。（２）将肺心病分为正常碳酸血症（Ａ组）、轻度高碳酸血症（Ｂ组）和重度高碳酸血症（Ｃ组），３组均有低氧血症，以Ｃ组最低，３组间相互比较，Ｐ均＜０．０１；一秒率（ＦＥＶ１％）、ＰＩｍａｘ、Ｐｄｉｍａｘ均明显降低，以Ｃ组最低，３组间相互比较，Ｐ均＜０．０１或＜０．０５；ＴＴｄｉ均延长，以Ｃ组最明显，３组间相互比较，Ｐ均＜０．０１。（３）动脉血二氧化碳分压（ＰａＣＯ２）与生理死腔与潮气量比值（ＶＤ／ＶＴ）和ＴＴｄｉ呈明显正相关，ｒ值分别为０．５７和０．５２，Ｐ均＜０．００１；与ＦＥＶ１％、ＰＩｍａｘ和Ｐｄｉｍａｘ呈明显负相关，ｒ值分别为－０．６１、－０．５１和－０．５８，Ｐ均＜０．００１。结论：高原肺心病患者吸气肌疲劳和膈肌储备力下降在其高碳?Objective:To assess relationship between inspiratory muscle dysfunction and the chronic hypercapnia in chronic cor pulmonale (HACCP) at high altitude.Methods:The pulmonary function,arterial blood gas,maximal inspiratory pressure (PImax),maximal transdiaphragmatic pressure (Pdimax) and tensiontime index of the diaphragmatic muscle (TTdi) were measured in 48 patients (mean aged 588 years)with HACCP in stable stage and 42 health subjects of similar ages (mean aged 563 years at 2 260￣3 200 meters above sea level.Patients with HACCP were divided into 3 groups according to PaCO2 levels:group A with normocapnia (9 cases),group B with mild hypercapnia (18 cases) and group C with severe hypercapnia (21 cases).Results:The mean PImax and Pdimax in the patients with HACCP were significantly lower and TTdi was significantly higher than those in the normal subjects (all P<001).Mean PaO2 in group C was significantly lower than that in groups A and B,and the differences among the 3 groups were significant (all P<001).The mean forced expiratory volume in one second to forced vital capacity ratio(FEV1 %),PImax and Pdimax in group C were significantly lower than those in the groups A and B respectively,and the differences among the 3 groups were significant (P<005～001).In addition,PaCO2 levels were positively correlated with the rate of VD/VT(r=057,P<0001) and TTdi (r=052,P<0001),while negatively correlated with FEV1%(r=-061,P<0001),PImax(r=-051,P<0001),and Pdimax(r=-058,P<0001),respectively.Conclusions:The results suggest that inspiratory muscle weakness and reduction of diaphragmatic muscle reserve in patients with HACCP may play an important role in the development of hypercapnia.

关 键 词：呼吸功能 呼吸肌 肺心病 高碳酸血症 

分 类 号：R541.5[医药卫生—心血管疾病]