摘要
对49例慢阻肺(COPD)和肺心病患者不同发展阶段的血液动力学和血气变化进行比较.结果:COPD常压组、COPD高压组和肺心病组之间其血液动力学和血气有差异,随病情发展,MPAP、TPR、HR、和PaCO_2逐渐增加,Cpa和PaO_2不断下降,CI和SVI无明显变化;COPD高压组与肺心病代偿组间,其血液动力学和血气变化非常接近;而肺心病代偿组与肺心病失代偿组间则有明显差别;在肺心病组28例中MPAP正常或接近正常8例(占28.6%),说明临床上不能凭一次测定MPAP正常就排除肺心病.并提出把肺心病分为:①隐性肺心病(肺心病前期);②早期肺心病(代偿期肺心病);③失代偿期肺心病(包括急性加重期和缓解期).
The changes of the haemodynamics and blood gas in various phases from COPD to cor pul monale were studied in 49 cases with COPD and cor pulmonale.The results showed that there were diff ences in the haemodynamics and blood gas among the COPD without HPH group (8 cases), the COPD with HPH group (13 cases) and the cor pulmonale group (28 cases).The differences were that mPAP,TPR, HR, PaCO_2 increased gradually and Cpa, PaO_2 decreased progressively during the process from COPD to cor pulmonale.But there were riot much.CI and SVI differences among these groups.The changes of the haemodynamics and blood gas between the COPD with HPH group and the compensative cor pulmonale group were similar, but there were obvious differences in the haemodynamics and blood gas between compensative cor pulmonale and decompensative cor pulmonale.In order to obtain early di agnosis and treatment of cor pulmonale in the clinic, we divided cor pulmonale into three stages:①Latent Cor Pulmonale or Earlier Stage of Cor Pulmonale (mPAP>2.67 kPa, without right ventricular hyper trophy).②Compensative Cor Pulmonale or Early Stage of Cor Pulmonale③Decompensative Cor Pul monale (including acute exacerbation and remission stage).There were 8 cases who had normal mPAP in 28 cases with cor pulmonale(28.6%).This indicated that the HPH was reversible in some patients with cor pulmonale.
关键词
肺心病
血液动力学
血气
COPD
cor pulmonale
haemodynamics
blood gas
