高原地区慢性肺心病低渗血症对肺性脑病的影响

Clinical Significance of Hyposmolarity in Pulmonary Encephalopathy Complicated with Chronic Cor Pulmoale at High Altitude

目的:探讨高原地区慢性肺心病低渗血症对肺性脑病的影响及其临床意义。方法:高原地区慢性肺心病急性加重期患者89例,根据血气分析及血浆渗透压将其分为3组:①肺脑组(肺性脑病组)36例;②混合组(肺性脑病合并低渗血症组)28例;③低渗组(低渗血症组)25例。对3组的血电解质、血气、血浆胶体渗透压及病死率进行比较。结果:低渗组和混合组的血浆渗透压(分别257．22±9．35 mOSm／L、258．83±11．20 mOSm／L)、血Na+(分别120．33±6．59 mmol／L、121． 76±5．35 mmol／L)、血K+(分别3．31±0．49 mmol／L、3．25±0．46 mmol／L)、血Cl-(分别89．36±5．67 mmol／L、87．54±4． 02 mmol／L)显著低于肺脑组(分别303．44±9．87 mOSM,L、142．85±4．12 mmol／L、4．68±0．53 mmol／L、105．51±4．30 mmol／L),均P<0．01;低渗组PaCO2(54．30±5．29 mmHg)显著低于肺脑组和混合组(分别69．40±6．02 mmHg、72．12±6． 15 mmHg),均P(0．01。低渗组和混合组病死率(分别40．0％、42．9％)显著高于肺脑组(11．11％),均P<0．01。结论:低渗血症可明显加重高原肺心病并发肺性脑病患者的病情,使死亡率增高。早期诊断及时治疗是改善患者预后的关键。

Objective： To determine the clinical significance of hyposmolarity in pulmonary encephalopathy complicated with chronic cot pulmoale at high altitude （HACCP）. Methods： Acording to the results of PaO2 ,PaCO2 and plasma osmotic pressure,89 patients with HACCP were divided into three groups： pulmonary encephalopathy group（36 cases）, pulmonary encephalopathy companied hyposmolarity group （28 cases） and hyposmolarity group （25 cases）. The electrolytes, arterial blood gas, plasma osmotic pressure and mortality of three groups were analyzed. Results： In hyposmolarity group and pulmonary encephalopathy companies hyposmolarity group, plasma osmotic pressure （257. 22 ± 9. 35mOSm/L and 258.83 ± 11.20 mOSm/L, respectively ）, Na^＋ （120. 33 ± 6. 59 mmol/L and 121.76 ± 5.35mmol/L, respectively）） ,K^＋ （3.31 ± 0. 49 mmol/L and 3. 25 ± 0, 46mmol/L, respectively） ） ,Cl^＋ （89. 36 ± 5. 67 mmol/L and 87. 54 ± 4. 02mmol/L, respectively））were significantly lower than those in pulmonary encephalopathy group （303. 44 ± 9. 87mOSM/L, 142. 85 ± 4. 12mmol/L, 4. 68 ± 0. 53mmol/L,105. 51 ± 4. 30 mmol/L, respectively） ,all P〈0. 01. PaCO2 of hyposmolarity group （54. 30 ± 5.29mmHg）was significantly lower than those of pulmonary encephalopathy group and pulmonary encephalopathy companied hyposmolarity group （69. 40 ± 6. 02mmHg and 72. 12 ± 6. 15mmHg, respectively） ,all P〈0.01. The mortality of hyposmolarity group and pulmonary encephalopathy companies hyposmolarity group （40. 0%,42. 9%, respectively） were significantly higher thant that of pulmonary encephalopathy group （11.11 % ）, all P〈0. 01. Conclusion： Hyposmolarity significantly affect the prognosis of HACCP patients with pulmonary encephalopathy,The accurate diognosis as early as possible and active theraphy was a key of importance of prognosis in the patients