慢性阻塞性肺疾病合并不同程度肺动脉高压的临床比较  

Clinical comparative study on chronic obstructive pulmonary disease patients with different degree of pulmonary hypertension

作　　者：陈小容[1] 邹霞英[1] 辛达临[1] 欧阳燕[1] 黄文杰[1] 

机构地区：[1]广州军区广州总医院全军呼吸中心,广州510010

出　　处：《广东医学》2013年第18期2792-2795,共4页Guangdong Medical Journal

摘　　要：目的比较研究慢性阻塞性肺疾病(COPD)合并严重肺动脉高压(平均肺动脉压,mPAP>40mmHg)患者,与非严重肺动脉高压(25 mmHg≤mPAP≤40 mmHg)患者的临床特点。方法回顾分析了132例行右心导管检查显示有肺动脉高压(mPAP≥25 mmHg)的稳定期COPD患者情况。男106例,女28例,年龄(64.1±7.2)岁。根据mPAP将患者分为3组,A组:25 mmHg≤mPAP≤30 mmHg,B组:30 mmHg<mPAP≤40 mmHg,C组:mPAP>40 mmHg。对3组患者的临床特征、右心漂浮导管检测、血气分析、氧动力学及呼吸功能检测结果进行比较分析。结果 (1)132例COPD合并肺动脉高压患者中,大多数为轻、中度肺动脉高压,A、B组分别占65.9%(87/132)、26.5%(35/132),严重肺动脉高压的C组比较少,只占7.6%(10/132)。(2)C组动脉血氧分压(PaO2)、动脉血氧含量(CaO2)及氧输送量(DO2I)明显低于A、B两组,差异有统计学意义(P<0.01)。A、B、C 3组的PaO2分别为(59.3±9.5)mmHg,(56.7±8.4)mmHg,(45.8±6.5)mmHg;A、B、C 3组的CaO2分别为:(16.9±2.5)vol%、(16.3±2.7)vol%、(14±2.8)vol%;A、B、C 3组的DO2I分别为:(601.8±148.3)mL/(min·m2)、(501.0±132.0)mL/(min·m2)、(348.1±57.0)mL/(min·m2)。(3)呼吸功能:用力肺活量(FVC)、第1秒用力肺活量(FEV1)及FEV1/FVC,3组间比较差异无统计学意义。结论 (1)COPD并肺动脉高压以轻、中度为主,严重肺动脉高压少,占7.6%左右。(2)COPD并发严重肺动脉高压组的低氧血症和DO2I减少较其他两组更为严重。Objective To compare the clinical characters between patients with COPD with and without severe pulmonary hypertension （mean pulmonary artery pressure, mPAP 〉 40 mmHg）. Methods Retrospective study of 132 COPD patients in stable stage with pulmonary hypertension （PH, mPAP≥25 mmHg） who underwent right heart catheterization between 1995 and 2005 in our department. Among them, 106 cases were males, with mean age of 64. 1 ± 7.2years. The 132 patients were divided into three groups according to mPAP： Group A （25 mmHg≤mPAP≤30 mmHg）, Group B （30 mmHg 〈 mPAP~〈40 mmHg, and Group C （mPAP 〉 40 mmHg）. The results of right heart catheterization, artery blood - gas analysis, and respiratory function tests were compared among three groups. Results Most of the 132 patients had mild and moderate PH （Group A accounted for 65.9% , 87/132; Group B accounted for 26. 5% , 35/ 132 ）. The PaO2, CaO2 and DO21 were significantly lower in Group C than the other two groups （P 〈 0. 01 ）. The PaO2 in Group A, B and C were 59.3 ±9. 5 mmHg, 56.7 ± 8.4 mmHg and 45.8±6. 5 mmHg, respectively; the CaO2 were 16. 9±2. 2VOL%, 16.3 ±2. 7VOL% and 14 ±2. 8VOL%, respectively; the DO2I were 601.8 ± 148.3 mL/min · m2, 501 ± 132 ml/min·m2 and 348.2±57 mL/min · m2, respectively. There was no significant difference in respiratory function, the forced expiratory volume （FVC） , the forced expiratory volume in one second （FEV1） and FEV1/FVC among the three groups. Conclusion The pulmonary hypertension in COPD patients is usually mild - to - moderate. The hypoxemia and decrease of DO21 are more severe in severe PH patients.

关 键 词：慢性阻塞性肺疾病 肺动脉高压 肺血流动力学 氧动力学 肺功能 

分 类 号：R563[医药卫生—呼吸系统]