稳定期慢性阻塞性肺疾病合并重度肺动脉高压的临床研究

Clinical study on chronic obstructive pulmonary disease patients in stable stage complicated with severe pulmonary hypertension

目的探讨稳定期慢性阻塞性肺疾病(COPD)合并重度肺动脉高压的临床特征及意义。方法985例COPD患者,排除其它影响肺血流动力学的因素,脉冲多普勒肺动脉血流频谱分析法测定肺动脉平均压,依据肺动脉压水平将患者分为肺动脉压正常组、轻中度升高组和重度升高组,比较3组患者Borg呼吸困难评分、肺功能检查及动脉血气分析参数。结果稳定期COPD患者重度肺动脉高压的发生率为6.39%(63/985),多为中重度患者;与肺动脉压正常及轻中度升高组患者相比,重度肺动脉高压组患者Borg呼吸困难评分较高,肺泡动脉氧分压差{A-aDO2}增大,第一秒用力呼气容积占预计值的百分比(FEV1%)、一氧化碳弥散量(DLCO)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)较低(P<0.05)。结论少数稳定期COPD患者合并重度肺动脉高压,这些患者血管疾病表现突出,需要运用血管扩张剂进行治疗。

Objective To investigate the clinical characteristics and clinical significance of chronic obstructive pulmonary disease （COPD） patients in stable stage complicated with severe pulmonary hypertension. Methods Nine hundred and eighty five cases of patients diagnosed with COPD and excluded other pulmonary hemodynamic influence were enrolled in the study. Mean pulmonary artery pressure （mPAP） was measured with pulse-wave mode Doppler echocardiography frequency spectrum analysis of pulmonary artery blood stream. The patients were divided into three groups： normal mPAP, mild to moderate mPAP, severe mPAP. The results of Borg scale, respiratory function tests and blood-gas analysis were compared among the groups. Results The incidence of severe pulmonary hypertension in COPD patients in stable stage was 6. 39% （63/985） and most of them were in moderate to severe clinical stage. The Borg scale and alveolar-artery oxygen pressure difference {A-aDO2} of patients with severe pulmonary hypertension were higher than patients with normal or moderate pulmonary hypertension, while the forced expiratory volume in one second （ FEV1）%, diffusion capacity for CO of lung （DLCO） , partial pressure of oxygen in arterial blood （PaO2 ） , and partial pressure of carbon dioxide in arterial blood （ PaCO2 ） were significantly lower （ P〈0.05 ）. Conclusions The minority of patients with COPD in stable stage were complicated with severe puhnonary hypertension and they presented the clinical feature of predominant vascular disease that requires vasodilators therapy.