高原地区肺源性心脏病急性发作期患者氧动力学变化的临床研究  

Clinical observation of oxygen dynamics in acute episode patients with cor pulmonale at high altitude

作　　者：孙东明[1] 张海明[1] 顾玉海[1] 李荧[1] 马四清[1] 

机构地区：[1]青海省人民医院麻醉科ICU

出　　处：《中国危重病急救医学》1999年第2期109-111,共3页Chinese Critical Care Medicine

基　　金：卫生部青年科研基金

摘　　要：目的：了解高原地区肺源性心脏病（肺心病）患者氧动力学的基本变化规律，为临床治疗提供理论依据。方法：利用ＳｗａｎＧａｎｚ导管及热稀释法心输出量测定技术对西宁地区２０例肺心病急性发作期患者进行临床监测。结果：在机械通气条件下，全部患者氧输送（ＤＯ２）水平在监测开始第１日略有升高，而氧耗量（ＶＯ２）升高不明显，二者之间无相关（ｒ＝０．０３２０，Ｐ＞０．０５）；第２～３日ＤＯ２继续升高到６００ｍｌ·ｍｉｎ－１·ｍ－２以上时，ＶＯ２亦随之升高，出现病理性氧供依赖（ｒ＝０．６５４７，Ｐ＜０．０５），在ＤＯ２超过７２０ｍｌ·ｍｉｎ－１·ｍ－２以后，ＶＯ２的上升趋于平缓，相关关系消失（ｒ＝０．１９４３，Ｐ＞０．０５），氧摄取率在ＤＯ２低于５５０ｍｌ·ｍｉｎ－１·ｍ－２时出现低水平代偿，以后均处于较低水平，与ＶＯ２呈负相关关系（ｒ＝－０．４０６８，Ｐ＜０．０１）。结论：肺心病患者氧摄取功能已出现明显障碍，致使ＤＯ２与ＶＯ２之间出现病理性氧供依赖；肺心病急性发作期患者存在“最佳氧供区间”。Objective:To observe the oxygen dynamics in acute episode patients with cor pulmonale at high altitude in order to provide the theoretical basis for clinical treatment.Methods:The oxygen dynamics was determined by SwanGanz catheter and thermodilution method in 20 acute episode patients with cor pulmonary in Xining city.Results:With mechanical ventilation,in all patients O 2 levels increased slowly on first day,while O 2 levels were not markedly elevated,no correlation between O 2 and O 2 was observed ( r = 0 032 0 , P >0 05).On the second and third days,as the level of O 2 increased over 600 ml·min -1 ·m -2 ,O 2 was also elevated,showing significant correlation between O 2 and O 2 ( r = 0 654 7 , P <0 05).However,when O 2 increased over 720 ml·min -1 ·m -2 ,O 2 reached a plateau,and the correlation disappeared ( r = 0 194 3 , P >0 05).When the level of O 2 was less than 550 ml·min -1 ·m -2 ,it showed a low level compensative response in O 2,with the negative correlation between two parameters ( r = -0 406 8 , P <0 01).Conclusions:Our data suggest that there exists a remarkable disturbance of oxygen uptake in patients with cor pulmonale,resulting in the pathological supply dependency between O 2 and O 2.In acute episode patients with cor pulmonale,the presence of “best oxygen supply area” indicates that it should be adjusted O 2 level to this area in the treatment of those patients for effective oxygen supply.

关 键 词：肺心病 氧输送 氧耗量 病理性 氧供依赖 高原 

分 类 号：R541.502[医药卫生—心血管疾病] R594.306[医药卫生—内科学]