肺动脉高压患者外周静脉血氧饱和度与血流动力学参数的相关性

Correlation between peripheral venous oxygen saturation and hemodynamic parameters in patients with pulmonary hypertension

目的 探讨肺动脉高压（PH）患者外周静脉血氧饱和度（SpvO2）与混合静脉血氧饱和度（SvO2）、肺血管阻力（PVR）及心指数等参数的相关性.方法 回顾分析2015年7月至2016年10月广州呼吸疾病研究所经右心导管术检查确诊PH的住院患者77例,其中男39例,女38例,年龄19 ～88岁,平均（52±15）岁.以SpvO2 ≥65％作为界值将患者分为SpvO2 ≥65％组（36例）与SpvO2＜65％组（41例）.收集有心导管术时SvO2、SpvO2、心排量及平均肺动脉压（mPAP）等参数,计算心排量指数（CI）和PVR等.将SpvO2分别与SvO2、心排量、CI、mPAP及PVR等参数进行相关性分析.结果 SpvO2 ＜65％组患者右心室和右心房舒张末期直径分别为（32±10）和（47±13） mm,SpvO2≥65％组分别为（28±6）和（41 ±8） mm;SpvO2 ＜65％组患者世界卫生组织心功能分级Ⅲ、Ⅳ级比例（31/41）高于SpvO2≥65％组（10/36）,SpvO2＜ 65％组CI为（2.4±1.0）,体循环收缩压和平均压为（110±19）和（82±14） mmHg（1 mmHg =0.133 kPa）,均低于SpvO2≥65％组[CI为（3.3±1.2）,体循环收缩压和平均压为（122±22）和（90±17） mmHg],PVR[（11±7） Wood U]高于SpvO2≥65％组[（7±5） Wood U,均P＜0.05].本组患者中SpvO2与SvO2、CI、PaO2呈正相关（均P＜0.05）,与PVR、全肺阻力、体循环阻力、有心房直径和右心室直径呈负相关（P＜0.05）.结论 SpvO2与SvO2有较好的一致性;SpvO2还可间接反应PH患者心指数、肺血管阻力及右心结构的改变.SpvO2可用于预测PH患者心指数、肺血管阻力及预后;SpvO2较低提示病情差,预后不良.

 Objective To investigate the correlation of peripheral venous oxygen saturation （SpvO2） with mixed venous oxygen saturation （SvO2）,pulmonary vascular resistance （PVR） and cardiac index （CI） in patients with pulmonary hypertension （PH）,in order to predict these parameters using SpvO2 and assess the prognosis of patients.Methods Hospitalized patients diagnosed with PH by right heart catheterization in the Guangzhou Institute of Respiratory Diseases from July 2015 to October 2016 were retrospectively analyzed.Parameters during the right heart catheterization,including SvO2,SpvO2,cardiac output （CO） and mean pulmonary arterial pressure （mPAP） were recorded,while CI,PVR and other parameters were indirectly calculated.The correlation between SpvO2 and SvO2,CO,CI,mPAP,PVR and other parameters were respectively analyzed and compared between groups.Results A total of 77 PH patients were selected,which comprised of 39 males and 38 females.The results revealed that SpyO2 was correlated positively with SvO2,CI and PaO2 （P 〈 0.05）,but negatively with PVR,total pulmonary resistance （TPR）,systemic vascular resistance,right atrial diameter and right ventricular diameter （P 〈0.05）.In the group with SpvO2 〈 65%,the dilation of the right atrium and right ventricle was more significant,the WHO heart function grade was worse,CI,systemic systolic pressure and mean systemic pressure were lower,and PVR and TPR were higher,as compared to those in the group with SpvO2 ≥65%.（P 〈0.05）.Conclusions There was good consistency between SpvO2 and SvO2.Furthermore,SpvO2 could indirectly reflect the CI,PVR and changes in right heart structure of PH patients,providing reference for the clinical prediction of CI and PVR,as well as the prognosis of PH patients,through the use of SpvO2.Low SpvO2 indicated a severe condition and poor prognosis.