机械通气缓解高原肺水肿患者舌下微循环和改善右心功能

Mechanical ventilation relieves sublingual microcirculation and improves right heart function in patients with high altitude pulmonary edema

目的探讨机械通气对高原肺水肿(HAPE)患者舌下微循环和右心功能的影响。方法将30例HAPE患者随机分为HAPE组(14例常规治疗)和MV组(16例机械通气治疗),随机选择平原急进高原未发生高原肺水肿健康志愿者20名为对照组。对MV组和HAPE组治疗前、治疗后、治愈后及对照组行总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微循环流动指数(MFI)及右心房左右径、右心室前后径、主肺动脉内径、肺动脉收缩压、血气分析的检测。同时观察MV组、HAPE组肺部啰音、肺部阴影消失时间、临床治愈时间。结果与对照组相比,MV组、HAPE组治疗前pH值增高;血氧饱和度(SaO2)下降;二氧化碳分压(PaCO2)下降;血乳酸(Lac)增高(P<0.01)。与HAPE组相比,MV组治疗后2 h和6 h能更快的缓解低氧血症、呼吸性碱中毒及降低血乳酸(P<0.05或P<0.01)。与对照组相比,MV组、HAPE组治疗前TVD、PVD、PPV、MFI值明显降低(P<0.01)。MV组治疗后24 h TVD、PVD、PPV、MFI值升高,优于HAPE组(P<0.05)。与对照组相比,MV组、HAPE组治疗前右心房左右径增大、右心室前后径增大、主肺动脉内径增宽、肺动脉收缩压增高(P<0.01)。MV组、HAPE组治疗后右心房左右径、右心室前后径、主肺动脉内径缩小、肺动脉收缩压降低,与治疗后24 h相比,MV组优于HAPE组(P<0.05)。与HAPE组相比,MV组能缩短肺部啰音及肺部阴影消失时间和临床治愈时间(P<0.01)。结论机械通气能迅速缓解低氧血症,明显改善微循环障碍及右心功能衰竭,从而缩短HAPE患者的临床治愈时间。

Objective To explore the effect of mechanical ventilation on sublingual microcirculation and right heart function in patients with high altitude pulmonary edema(HAPE).Methods Thirty HAPE patients were randomly divided into HAPE group(conventional treatment)with 14 cases and MV group(mechanical ventilation treatment)with 16 cases,20 healthy volunteers who did not develop HAPE were randomly selected as the control group.We performed tests including the total of perfused vessel density(TVD),perfused vessel density(PVD),proportion of perfused vessels(PPV)and microcirculation flow index(MFI),left and right diameter of right atrium,anteroposterior diameter of right ventricle,internal diameter of main pulmonary artery,pulmonary artery systolic pressure,blood gas analysis in HAPE group before-after treatment,after healing and in control group.At the same time,the lung rales,lung shadow disappearance time,and clinical cure time were observed in the MV group and HAPE group.Results Compared with the control group,the pH value of the MV group and the HAPE group increased before treatment;blood oxygen saturation(SaO2)decreased;carbon dioxide partial pressure(PaCO2)decreased;blood lactic acid(Lac)increased(P<0.01).Compared with the HAPE group,the MV group relieved hypoxemia,respiratory alkalosis and reduced blood lactic acid more quickly after 2 h or 6 h treatment(P<0.05 or P<0.01).Compared with the control group,the TVD,PVD,PPV and MFI values of the MV group and the HAPE group were significantly lower than those before treatment(P<0.01).The TVD,PVD,PPV and MFI values of the MV group increased after 24 h treatment,which were better than those of the HAPE group(P<0.05).Compared with the control group,the left and right atrium diameters of the MV and HAPE groups increased before treatment,the anteroposterior diameter of the right ventricle,the inner diameter of the main pulmonary artery,and the pulmonary artery systolic pressure all significantly increased(P<0.01).After treatment,the left and right diameters of the right atrium,the anteroposterior diameter of the right ventricle,the internal diameter of the main pulmonary artery,and the systolic pressure of the pulmonary artery all decreased in MV group and HAPE group.After 24-hour treatment,MV group was better than the HAPE group(P<0.05).Compared with HAPE group,the MV group did shorten the disappearance time of lung rales and shadows,and the clinical cure time(P<0.01).Conclusions Mechanical ventilation may quickly relieve hypoxemia,significantly improve microcirculation disorders and right heart failure,thereby shorten hospitalization of patients with HAPE.