高原肺水肿患者再缺氧损伤的观察  

The observation of the rehypoxic injury in patients with high altitude pulmonary edema

作　　者：牟信兵[1] 李素芝[1] 高钰琪[2] 刘福玉[2] 叶刚林[1] 汤红亚[1] 周小波[1] 陈光林[1] 

机构地区：[1]西藏军区总医院全军高山病防治研究中心,拉萨850003 [2]第三军医大学高原医学系,重庆400038

出　　处：《中华航空航天医学杂志》2003年第2期110-112,共3页Chinese Journal of Aerospace Medicine

基　　金：全军十五指令性课题 (0 1L 0 62 )

摘　　要：目的　评价氧疗在高原肺水肿治疗中的作用。　方法　采用右心漂浮导管检测法 ,观察了 8例高原肺水肿患者吸入纯氧及突然停止吸氧对患者肺动脉的影响 ,同时采用 L ake L ouise评分法对患者的病情进行定量评估。　结果　高原肺水肿患者肺动脉平均压在吸氧 1min后逐渐明显下降 ,患者在突然停止吸氧而改吸室内空气后 ,下降的肺动脉压逐渐回升 ,10 m in后回复到吸氧前水平 ,但随着时间的延长 ,肺动脉压继续攀升 ,2 0 m in后肺动脉压已明显高于吸氧前水平 ,2 5 min后肺动脉压达最高值 ,与此同时 ,高原肺水肿患者病情定量分数亦显著高于吸氧前。　结论　高原肺水肿患者存在着再缺氧损伤 ,而肺动脉压异常升高在其发生中起重要作用。Objective To improve the therapeutic effects of inhaling O_2 in patients with high altitude pulmonary edema (HAPE). Methods With the agreement of 8 HAPE patients, the pulmonary arterial pressure (PAP) was measured by Swan-Ganz thermistor catheters before O_2 inhalation, during 50% O_2 inhalation by 20 min and during discontinuing O_2 inhalation by 30 min. The clinical severity of HAPE of subjects was assessed by Lake Louise acute mountain sickness scoring system. Results The PAP of the patients was lowered significantly after 1 min O_2 inhalation as compared with initial value, and reached to the lowest level after 5 min O_2 inhalation. The reduced PAP became higher up to the initial value after 10 min and up to the highest level after 25 min discontinuing of O_2 inhalation which was significantly higher than initial value. Lake Louise scores of HAPE at this time were also significantly higher than the initial value. Conclusions It is suggested that rehypoxic injury may occur in patient with HAPE after discontinuing O_2 inhalation, and pulmonary hypertension is essential in the pathogenesis of rehypoxic injury.

关 键 词：高原肺水肿 再缺氧损伤 肺动脉高压 

分 类 号：R594.3[医药卫生—内科学]