高原慢性肺源性心脏病急性加重期患者周围性水肿发生机制的研究  

The cause of peripheral edema in 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]西宁解放军第四医院

出　　处：《中国危重病急救医学》1999年第2期99-101,共3页Chinese Critical Care Medicine

基　　金："九五"军队医药卫生科研基金

摘　　要：目的：探讨高原慢性肺源性心脏病（肺心病）急性加重期周围性水肿的发生机制。方法：对高原（海拔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例病情相似而无周围性水肿的患者（Ｃ组）作对比研究。结果：Ａ组右室射血前期（Ｑｂ间期）、右室射血前期／右室射血期（Ｑｂ／ｂｙ比值）、肺动脉平均压（ｍＰＡＰ）、肺血管阻力（ＰＶＲ）、动脉血二氧化碳分压（ＰａＣＯ２）、尿素氮（ＢＵＮ）、肌酐（Ｃｒ）及血钠（Ｎａ＋）明显高于Ｂ组，而ｂｙ间期、心输出指数（ＣＩ）、心搏指数（ＳＩ）、动脉血氧分压（ＰａＯ２）明显低于Ｂ组（Ｐ均＜０．０１）；Ｂ组除ＰａＯ２明显低于Ｃ组、ＰａＣＯ２和Ｎａ＋明显高于Ｃ组（Ｐ均＜０．０１）外，余各项指标Ｂ、Ｃ２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 peripheral edema in chronic cor pulmonale (CCP) during acute stage induced by chronic obstructive pulmonary disease (COPD) at high altitude.Methods:Hemodynamics,arterial blood gases,serum protein,renal function and serum Na + were measured in 82 CCP patients with peripheral edema and in 75 CCP patients without peripheral edema (group C) at high altitude (2 260～ 3 200 m ).According to degree of edema,the 82 patients were divided into two groups:severe (group A,33 cases) and mildmoderate edema (group B,49 cases).Results:Qb interval,Qb/by ratio,mean pulmonary arterial pressure (mPAP),pulmonary vascular resistance (PVR),PaCO 2,BUN,Cr and serum Na + in group A were significantly higher than those in group B (all P <0 01),by interval,cardiac index,stroke index and PaO 2 in group A were significantly lower than those in group B (all P <0 01).PaCO 2 and serum Na + were significantly higher in group B than in group C (all P <0 01),while PaO 2 in group B was markedly lower compared with group C ( P <0 01).Conclusions:The results suggest that the development of severe edema in chronic cor pulmonale at high altitude appears to be related to a complex mechanism,including right heart dysfunction,hypoxia and hypercapniainduced natrium and water retention.Nevertheless,the development of mildmoderate edema in chronic cor pulmonale at high altitude may not be attributed to right heart function,but be related to hypoxia and hypercapniainduced natrium and water retention.

关 键 词：阻塞性肺疾病 慢性 周围性水肿 高原 肺心病 

分 类 号：R541.502[医药卫生—心血管疾病] R442.5[医药卫生—内科学]