老年人肺心病的脑循环动力学研究

Clinical study of cerebral hemodynamics in elderly patients with corpulmonale

目的探讨肺心病人脑循环动力学(CAV)异常改变及引起CVA改变的相关因素。方法对50例肺心病人行CVA、血气分析、血流变学、纤维蛋白原(Fg)检测,正常对照组30例行CVA检测,分别列表对照分析。结果肺心病组较正常对照组CVA各参数有明显异常改变,差异有统计学意义(P<0.05或P<0.01)。缓解期病人组较急性发作期病人组CVA参数有明显改善,差异有统计学意义(P<0.05或P<0.01)。对肺心病影响显著的因素,依次为二氧化碳分压升高(PaCO2↑)、Fg↑、动脉氧分压降低(PaO2↓)、血粘度↑、红细胞压积增大等。结论COPD、肺心病、肺脑病人存在CVA异常改变。CVA异常改变随病情加重而加重,随病情缓解而改善,为临床判断该类病人病情提供了新的检测方法,并为该类病人使用扩血管药、降血粘度、抗凝、改善脑循环、促脑代谢药提供了依据。明确了引起该类病人CVA异常改变的因素及肺脑发生的主要原因是脑循环障碍。

Objective To investigate the abnormal changes of cerebral hemodynamics in patients with chronic obstructive pulmonary disease （COPD）, cor pulmonale and pulmono cerebral syndrome. Methods The cerebral hemodynamics, blood gas analysis, blood rheology, fibrinogen were determined in 50 patients and cerebral hemodynamics was determined in 30 healthy subjects as control. Results There were significant differences in cerebral hemodynamics parameters between the two groups （P 〈 0. 05-0. 01）. Cerebral hemodynamics parameters revealed a marked amelioration during the remission phase as compared with acute episode phase （P〈0. 05-0. 01）. The factors influencing cor pulmonale, COPD, and pulmono-cerebral syndrome in the descending order were high levels of PaCO2 and fibrinogen, low levels of PaO2, and high levels of blood viscosity and hematocrit. Conclusion There are abnormal changes of cerebral hemodynamies in patients with COPD, cor pulmonale, pulmono-cerebral syndrome and the changes are linked with the state of the illness. The detection of cerebral hemodynamics can be used as a new approach to evaluate these patients and will provide the evidence on which to base clinical treatment.