慢性阻塞性肺疾病相关性肺动脉高压的血流动力学和肺功能研究

Study of hemodynamics and pulmonary function in patients with chronic obstructive pulmonary disease associated pulmonary hypertension

目的分析慢性阻塞性肺疾病(COPD)相关性肺动脉高压(PH)的血流动力学和肺功能的变化,为治疗COPD患者提供科学依据。方法选取2014年3月~2016年7月我院收治的92例COPD相关性PH患者作为研究对象,按照疾病类型分为严重COPD相关性肺动脉高压组(严重组)与非严重COPD相关性肺动脉高压组(非严重组),每组各46例。分析两组血流动力学指标(肺动脉平均压、肺动脉楔压、肺血管阻力、右房压、心指数)和肺功能参数指标(峰流速、最大通气量、残气量、最大呼气中期流量、气道阻力、深呼吸气量)的变化。结果两组肺动脉平均压、肺动脉楔压、肺血管阻力、右房压、心指数比较,差异有统计学意义(P<0.05),严重组低氧血症较为显著,COPD相关性PH的低氧程度越严重,血流动力学受损程度越显著。两组峰流速、最大通气量、残气量、最大呼气中期流量、气道阻力、深呼吸气量肺功能参数指标比较,差异无统计学意义(P>0.05)。结论 COPD相关性PH患者存在血流动力学受损,严重COPD相关性PH患者的低氧血症较为显著,可能与肺血管因素有关。

Objective To analyze change of hemodynamics and pulmonary function in patients with chronic obstructive pulmonary disease（COPD） associated pulmonary hypertension（PH）,and to provide scientific basis for the treatment of COPD.Methods 92 patients with COPD associated PH in our hospital from March 2014 to July 2016 were selected as research object and divided into severe COPD associated PH group（severe group） and non severe COPD associated PH group（non severe group） according to the type of disease,46 cases in each group.Changes of hemodynamic parameters（mean pulmonary arterial pressure,pulmonary wedge pressure,pulmonary vascular resistance,right atrial pressure,cardiac index） and parameters of pulmonary function（peak velocity,maximal ventilatory volume,residual volume,maximal midexpiratory flow,airway resistance,deep breathing volume） were analyzed in two groups.Results Pulmonary artery average pressure,pulmonary wedge pressure,pulmonary vascular resistance,right atrial pressure,cardiac index was statistically significant（P〈0.05） between two group,hypoxemia in the severe group was more significant,hypoxia degree of COPD associated PH was more serious,impairment degree of hemodynamic was more significant.Peak velocity,maximal ventilatory volume,residual volume,maximal midexpiratory flow,airway resistance,deep breathing volume pulmonary function index was not statistically significant between two groups（P〉0.05）.Conclusion Patients with COPD associated PH have hemodynamic impairment,hypoxemia in patients with severe COPD associated PH is significant,but the hypoxemia in patients with severe COPD associated PH is significant,and may be related to pulmonary vascular factors.