摘要
目的观察慢性阻塞性肺病(COPD)不同病情下氧动力学的变化,探讨其临床意义。方法对166例COPD患者进行20年跟踪随访,并运用右心漂浮导管结合血气分析,检测其血流与氧动力学的变化,对其中COPD和并发肺动脉高压(PH)、COPD和并发呼吸衰竭、COPD死亡和生存、COPD急性和缓解期进行对比研究,并对40例COPD并PH用消心痛进行干预。结果116例死亡,总病死率69.9%。单纯COPD、COPD稳定期、COPD存活者平均肺动脉压(mPAP)、心脏指数(CI)、总肺血管阻力(TPR)、氧供(DO2)尚保持在相对正常水平,氧耗(VO2)及氧摄取率(O2-ER)呈低水平;COPD并PH、呼衰、COPD急性期及死亡者首诊时的CI、DO2、VO2、O2-ER显著低于单纯COPD、COPD稳定期、COPD存活者,而mPAP、TPR显著增高(P<0.05,P<0.01);消心痛干预后CI、DO2、O2-ER显著上升,mPAP、TPR显著降低(P<0.05,P<0.01)。结论单纯COPD、COPD稳定期、COPD存活者,呈现低氧性非氧供依赖;COPD如急性加重或并发PH、呼衰、或死亡者,出现病理性氧供依赖;消心痛干预可增加氧供;氧供与氧耗严重降低可能是COPD死亡的危险因素。
Objective To observe the changes of oxygen dynamics in patients with chronic obstructive pulmonary disease （COPD） and analyze its clinical importance. Methods The Swan-Gans catheters combined with arterial blood gas analysis were used to measure the parameters of blood and oxygen dynamics in 166 patients suffering from COPD during the period of 1977 - 1984. Those complicated pulmonary hypertension （PH） or respiratory failure （RF）, during the exacerbation or remission period, and the dead or the survived were comparatively studied within 20 years of follow-up （from 1984 to 2004）. Results Totally 116 out of 166 patients died with death rate of 69.9%. The mean pulmonary arterial pressure （mPAP）, cardiac index （CI）, total pulmonary vascular resistance （TPR）, oxygen delivery （DO2 ） were within normal ranges, and the oxygen consumption（VO2） and oxygen uptake rate（O2-ER） kept at relatively low levels in patients with simple COPD or in a stable period or still alive ; whereas in patients with COPD concurrent PH, RF, or in an exacerbation period or died, CI, DO2, VO2,O2-ER were significantly lowered and mPAP and TPR were significantly increased （P 〈 0.05 or 0.01 ）. After isoket intervention, the CI, DO2, and O2-ER in patients with COPD associated with PH were significantly increased and the mPAP, TPR decreased. Conclusion Patients suffering from COPD without PH, RF or in a stable period or still alive have a low level of balance for oxygen delivery and demand, and maintain a non-oxygen dependent status. When COPD exacerbated or associated with PH or RF, or patients died, this balance will be disturbed and patients are in oxygen-depended status. Vasodilators such as isoket can increase oxygen delivery. Extreme diminishment of oxygen supply and consumption are probably the dangerous factors responsible for the death of COPD.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2007年第19期1902-1905,共4页
Journal of Third Military Medical University
关键词
肺疾病
慢性阻塞性
氧供给
氧消耗
pulmonary disease
chronic obstructive
oxygen delivery
oxygen consumption
