危重病人的氧动力学改变

Changes of oxydynamics in critical cases

目的：研究肺心病失代偿期和脓毒症患者入院早期（６～４８ｈ）的血液动力学和氧动力学改变。方法：采用漂浮导管检查术，测定肺动脉压（ＰＡＰ）、右心室压（ＲＶＰ）、肺楔压（ＰＣＷＰ）、中心静脉压（ＣＶＰ）、外周动脉压（ＡＰ）、心排量（ＣＯ）和动脉血、混合静脉血行血气分析并同步测定混合静脉血ＬＡ。结果：肺心病失代偿期患者（Ｇ１组）：肺动脉平均压（ｍＰＡＰ）和肺循环阻力（ＰＶＲＩ）均显著升高，氧供（ＤＯ２）显著降低，上述改变以入院２４ｈ为甚；脓毒症组（Ｇ２组）：心指数（ＣＩ）显著增加，体循环阻力显著降低，ＤＯ２和氧消耗（ＶＯ２）大致正常，但乳酸水平显著升高。结论：Ｇ１组患者以肺循环高阻力和氧供不足为特征；而Ｇ２组患者以高排低阻，高代谢及氧利用障碍为特点。

Objective: To investigate the changes of hemodynamics and oxydynamics in critical patients with decompensable cor pulmonale or sepsis. Methods: PAP, RVP, PCWP, CVP, AP, CO and LA were measured using SwanGanz catheterization. Meanwhile, bloodgas analysis of arterial blood and mixed venous blood was conducted. Results: In patients with decompensable cor pulmonale (group 1), pulmonary arterial mean pressure and pulmonary vascular resistance index were significantly increased but oxygen delivery markedly decreased. In patients with sepsis (group 2), cardiac output index was remarkably increased while systemic vascular resistance index markedly decreased. Though DO2 and oxygen consumption were relatively normal, the lactic acid was significantly increased. Conclusion: Patients in group 1 show a high pulmonary vascular resistance with insufficient oxygen delivery and those in group 2 have a high cardiac output with low systemic vascular resistance, high metabolism and obstacle of oxygen usage.