先天性心脏病伴重度肺动脉高压患者动脉氧分压与肺细小动脉形态变化的关系  

The Relationship between PaO_2 and micro morphology of pulmonary vessel

作　　者：马胜军[1] 刘桂清[1] 马增山[1] 董铭锋[1] 柴守栋[1] 张学俊[1] 马振英 

机构地区：[1]聊城市人民医院,山东聊城252000 [2]临清市人民医院

出　　处：《山东医药》2004年第6期1-3,共3页Shandong Medical Journal

基　　金：山东省科学技术厅星火计划资助项目(No.0 2 2 1 30 1 6 1)

摘　　要：目的　探讨先天性心脏病 (CHD)合并重度肺动脉高压 (PH)患者动脉血气氧分压 (Pa O2 )在应用前列腺素 E1(PGE1)及卡托普利治疗过程中的变化幅度与肺细小动脉形态改变的关系。方法　 3 8例 CHD合并重度 PH患者入院后静滴 PGE110～ 15ng/ (kg.min) ,每天用药 12小时 ,连续 15天。同时口服卡托普利 1～ 2 m g/(kg.d)。分别于用药 0、 5、 10、 15天早晨安静状态下抽取股动脉血行血气分析 ,记录 Pa O2 。术中取肺组织活检 ,观察肺细小动脉的病理改变。结果　所有肺活检标本按 Heath与 Edwards分类法进行病理分级 : 级 2 1例 , 级 8例 , 级 3例 ;≥ 级 (紫绀者 ) 6例。应用 PGE1及卡托普利治疗前 ,随着肺细小动脉病理分级的增加 ,Pa O2 呈逐渐下降趋势 ;治疗后 ,肺细小动脉病理分级 级、 级者用药 5天 Pa O2 明显升高 ,10天、l5天时一直保持逐渐增加趋势 (P <0 .0 5,P <0 .0 1) ; 级者轻度升高 (P <0 .0 5) ;而≥ 级患者 ,治疗期间 Pa O2 无明显变化 (P >0 .0 5)。结论　在应用 PGE1及卡托普利治疗过程中 ,Pa O2 的变化幅度与肺细小动脉病理改变程度有较密切关系 。Objective To research the rela tionship between PaO 2 and micromorpholo gy of pulmonary vessels Methods 38 patients in congenital heart dise a se(CHD) with severe pulmonary hypertensi on(PH) were chosen randomly in this st udy Prostin E 1(PGE 1) was infused at a speed 10～15ng/(kg·min),12 hours a day fo r 15 days Captopril was taken at the same time at the dose 1～2 mg/(kg·d) Blo od sample was taken from femoral artery on th e day before the medicine was used and o n the 5th,10th and 15 th day aft er the medicine was used The PaO 2 was d etect,and the active tissue sample of lu ng was taken during the operation for st udy ResultsThe patients we re classified according to Heath0Ewards pulmonary ves sel pathologic grading:21 to grade Ⅱ,8 t o grade Ⅲ,3 to grade Ⅳ,6 to grade Ⅴ~Ⅵ Th e PaO 2 descends from grade Ⅱ to grade Ⅵ before the medicine and incre ased obviously on the 5th day,10th and 15th day(P<0 05,P<0 01) PaO 2 of cas es with grade Ⅳ increased lightly(P<0 05)and 6 cases with grade Ⅴ and grade Ⅵ maintained at a l ow level without reflecting Conclu sions A n intimate relationship detectcd between t PaO 2 and the pulmonary vessel micromo rphology during use of PGE 1 and Cap topril PaO 2 may be as a precise preoper a tive parameter to differentiat pulmonary vessel micromorphology of the patients

关 键 词：先天性心脏病 重度肺动脉高压 动脉氧分压 肺细小动脉 形态学 并发症 

分 类 号：R541.1[医药卫生—心血管疾病] R543.2[医药卫生—内科学]