高原慢性肺心病急性加重期周围性水肿发生机理的研究  

THE CAUSE OF PERIPERAL EDEMA IN CHRONIC COR PULMINALE 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：《高原医学杂志》1998年第4期15-17,共3页Journal of High Altitude Medicine

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（２２６０ｍ～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。Objective:To investigate the cause of periperal edema in chronic cor pulmonale(CCP) in acrte stage induced by COPD at high altitude.Methods:Hemodynamics,arterial blood gases,serum protein renal function and serum Na + were measured in 82 CCP patients with periperal edema and in 75 CCP patients without periperal edema (group C) at high altitude(2 260m～ 3 200 m).According to degree of edema,the 82 patients were divided into two groups:severe(group A,33 cases) and mild-moderate edema(group B,49 cases).Results:Q-b interval,Q-b/b-y rate,mPAP,PVR,PaCO 2,BUN Cr and serum Na + in group A were significantly higher than those in group B(all P <0 01),b-y interval,CI,SI and PaO 2 in group A were significantly lower than those in group B (all P <0 01),PaCO 2 and serum Na + in group B were significantly hither than those in group C(all P <0 01),PaO 2 in group B was significantly lowere than that in group C( P <0 01).Conclusion:The results suggest that the development of severe edema in chronic cor pulmonale at high altitude was related to a complex echanism,right herat dysfunction hypoxia and hypercapnia induced natrium and water retention.The development of mildmoderate edema in chronic cor pulmonale at high altitude was not related to right heart function and may be related to hypoxia and hypercapnia induced natrium and water retention.

关 键 词：肺心病 水肿 高原 

分 类 号：R541.506[医药卫生—心血管疾病] R442.5[医药卫生—内科学]