肺结核并慢性肺心病病人肺换气功能的初步研究

Study on Gas Exchange of Patients with Tuberculosis Complicated by Cor Pulmonale

肺结核并慢性肺心病病人缓解期肺换气功能特点为低氧血症,氧离曲线略左移和肺泡通气正常。发生呼吸衰竭时的共同特点为进一步加重的低氧血症。此外,Ⅰ型呼衰氧离曲线左移,肺泡通气正常或过度;Ⅱ型呼衰与此相反。呼衰并心衰后主要影响氧合功能。呼衰发生时的氧合和肺泡通气状态在缓解组与死亡组之间无显著性差异,救治后缓解组氧合状态明显改善;死亡组与之相反。而肺泡通气的改善则因型而异。应选择PaO_2/F_1O_2、P_(50)和PaCO_2作为肺结核病人重症监护的指标。

The characteristics of gas exchange in the patients with tuberculosis complicated by cor pulmonale were hypoxemia, slight left shift of dissciation curve for oxyhemoglobin and normal ventilation in the recovery. When patients suffered from respiratory failure, their hypoxemia was worsened. In addition, the patients with type I respiratory failure presented the left shift of dissociation curve for oxyhemoglobin and normal or hyper-ventilation, while type I patients presented the opposit. Respiratory failure complicated by right heart failure mainly worsened oxygenation, There were no significant differences in the oxygenation and ventilation between the recovery group and death group when respiratory failure occurred. The oxygenation in the recovery group was improved after treatment, and but not in the death group. The improvement of ventilation varied with the types of respiratory failure. The PaO2/F1O2, P50 and PaCO2 should be selected as the indexes for the intensive care of the patients with tuberculosis.