高原肺心病急发期时左心功能与氧输送关系

Relationship between left cardiac function and oxygen transport of cor pulmonale during acute attack at high altitude

目的研究高原地区肺心病急性发作期左心功能与氧输送的关系，将有益于肺心病的防治。方法２０例急发期肺心病患者１６例为成活组，４例为死亡组，均经颈内静脉置入Ｓｗａｎ－Ｇａｎｚ导管至肺动脉，用热稀释法直接测得心输出量（ＣＯ）。结果（１）肺心病患者心脏指数下降（２．９±０．４Ｌ·ｍｉｎ－１·ｍ－２）、平均肺动脉压（４．９±１．３ｋＰａ）及肺动脉嵌压（１．５±０．８ｋＰａ）升高，左室每搏作功指数下降（３５±１１ｇ·ｃｍ－１·ｍｉｎ－１）；（２）进行综合治疗之后，成活组上述指标改善，心脏指数、左室每搏作功指数增加，死亡组左室每搏作功指数继续下降，平均肺动脉压（ｍＰＡＰ），肺动脉嵌压改善不明显；（３）左室每搏作功能指数与氧输送二者有显著性相关（ｒ＝０．４３１８，Ｐ＜０．０５）。结论肺心病左室每搏作功指数直接影响氧输送水平。

Objective Relationship between left cardiac function and oxygen transport in the patients with cor pulmonale during acute attack at high altitude was studied to benefit prevention and treatment of cor pulmonale. Method 20 cases were divided into 16 as a surviving group and 4 as a death group. CO was determined by Swan Ganz catherter from internal carotid vein to pulmonary artery directly. Result (1) CI in the patients decreased (2.9±0.4 L·min -1 ·m -2 ). mPAP (4.9±1.3 kPa) and PAWP (1.5±0.8 kPa) increased. LVSWI (35±11 g·cm -1 ·min -1 ) dropped. (2) above Indicies in surviving group improved after comprehensive treatment. CI and LVSWI increased. But LVSWI in death group continued to decline. mPAP and PAWP were not changed; (3) There was significant corelation between LVSVI and DO 2 ( r =0.4318, P <0.05). Conclusion LVSWI of cor pulmonale could affect DO 2 level directly and closely relate to prognosis.