摘要
目的：探讨高原肺心病患者吸气肌功能失调与高碳酸血症的关系。方法：测定４８例高原（海拔２２６０～３２００ｍ）慢性肺心病缓解期患者肺功能、血气、口腔最大吸气压（ＰＩｍａｘ）、最大跨膈压（Ｐｄｉ－ｍａｘ）和膈肌张力时间指数（ＴＴｄｉ），并与４２例当地同龄健康人对比。结果：（１）肺心病组ＰＩｍａｘ、Ｐｄｉｍａｘ明显低于健康组（Ｐ均＜０．０１），ＴＴｄｉ较健康组明显延长（Ｐ＜０．０１）。（２）将肺心病分为正常碳酸血症（Ａ组）、轻度高碳酸血症（Ｂ组）和重度高碳酸血症（Ｃ组），３组均有低氧血症，以Ｃ组最低，３组间相互比较，Ｐ均＜０．０１；一秒率（ＦＥＶ１％）、ＰＩｍａｘ、Ｐｄｉｍａｘ均明显降低，以Ｃ组最低，３组间相互比较，Ｐ均＜０．０１或＜０．０５；ＴＴｄｉ均延长，以Ｃ组最明显，３组间相互比较，Ｐ均＜０．０１。（３）动脉血二氧化碳分压（ＰａＣＯ２）与生理死腔与潮气量比值（ＶＤ／ＶＴ）和ＴＴｄｉ呈明显正相关，ｒ值分别为０．５７和０．５２，Ｐ均＜０．００１；与ＦＥＶ１％、ＰＩｍａｘ和Ｐｄｉｍａｘ呈明显负相关，ｒ值分别为－０．６１、－０．５１和－０．５８，Ｐ均＜０．００１。结论：高原肺心病患者吸气肌疲劳和膈肌储备力下降在其高碳?
Objective:To assess relationship between inspiratory muscle dysfunction and the chronic hypercapnia in chronic cor pulmonale (HACCP) at high altitude.Methods:The pulmonary function,arterial blood gas,maximal inspiratory pressure (PImax),maximal transdiaphragmatic pressure (Pdimax) and tensiontime index of the diaphragmatic muscle (TTdi) were measured in 48 patients (mean aged 588 years)with HACCP in stable stage and 42 health subjects of similar ages (mean aged 563 years at 2 260￣3 200 meters above sea level.Patients with HACCP were divided into 3 groups according to PaCO2 levels:group A with normocapnia (9 cases),group B with mild hypercapnia (18 cases) and group C with severe hypercapnia (21 cases).Results:The mean PImax and Pdimax in the patients with HACCP were significantly lower and TTdi was significantly higher than those in the normal subjects (all P<001).Mean PaO2 in group C was significantly lower than that in groups A and B,and the differences among the 3 groups were significant (all P<001).The mean forced expiratory volume in one second to forced vital capacity ratio(FEV1 %),PImax and Pdimax in group C were significantly lower than those in the groups A and B respectively,and the differences among the 3 groups were significant (P<005～001).In addition,PaCO2 levels were positively correlated with the rate of VD/VT(r=057,P<0001) and TTdi (r=052,P<0001),while negatively correlated with FEV1%(r=-061,P<0001),PImax(r=-051,P<0001),and Pdimax(r=-058,P<0001),respectively.Conclusions:The results suggest that inspiratory muscle weakness and reduction of diaphragmatic muscle reserve in patients with HACCP may play an important role in the development of hypercapnia.
出处
《中国危重病急救医学》
CSCD
1998年第2期79-82,共4页
Chinese Critical Care Medicine
关键词
呼吸功能
呼吸肌
肺心病
高碳酸血症
respiratory function\ \ respiratory muscle\ \ chronic cor pulmonale at high\ \ altitude
