摘要
目的：观察慢性呼吸衰竭（呼衰）患者的氧动力学变化。方法：观察５２例呼衰患者的氧动力学变化，并以慢性阻塞性肺病（ＣＯＰＤ）未合并呼衰的１２例患者作对照，所有患者均随访１年；对其中１５例呼衰患者应用消心痛肺动脉滴注，观察治疗前后的变化。结果：呼衰患者氧运输量（ＤＯ２）、氧耗量（ＶＯ２）、心脏指数（ＣＩ）、动脉血氧分压（ＰａＯ２）和混合静脉血氧分压（ＰｖＯ２）均明显低于对照组；平均肺动脉压（ＭＰＡＰ）、肺血管阻力（ＰＶＲ）均高于对照组；呼衰患者ＤＯ２降低至≤０．４５０Ｌ·ｍｉｎ－１／ｍ２，ＤＯ２与ＶＯ２呈线性相关（ｒ＝０．６６），为病理性ＶＯ２氧依赖关系。随访１年ＣＯＰＤ组无死亡，５２例呼衰患者死亡８例（１３．５％），其ＤＯ２为０．２２２～０．３８０Ｌ·ｍｉｎ－１／ｍ２，平均（０．２８１±０．０４７）Ｌ·ｍｉｎ－１／ｍ２。消心痛治疗后ＰａＯ２与ＣＩ无明显变化，ＭＰＡＰ、ＰＶＲ分别由（４．７０±０．８０）ｋＰａ和（５６．６±１３．６）ｋＰａ·ｓ／Ｌ降至（３．３０±０．４０）ｋＰａ和（４２．８±１１．４）ｋＰａ·ｓ／Ｌ，ＤＯ２由（０．４５３±０．１６４）Ｌ·ｍｉｎ－１／ｍ２上升至（０．５０６±０．１１６）Ｌ·ｍｉｎ－?
Objective:To explore the oxygen dynamic changes in patients with chronic respiratory failure (CRF).Methods:Changes in oxygen dynamics in 52 patients with CRF were observed in this study,and 12 chronic obstructive pulmonary disease (COPD) patients without CRF served as controls.Additionally,the oxygen dynamic changes were observed in 15 out of 52 patients before and after intrapulmonary artery instillation of isosorbide dinitrate (ISD).Results:In the CRF group,oxygen delivery (O2),oxygen consumption (O2),cardiac index (CI),arterial oxygen partial pressure (PaO2) and mixed venous oxygen partial pressure (PvO2) were significantly lower than those in controls.Whereas mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance (PVR) were significantly higher compared with the control group.Linear reductions in O2 with O2 (r=066) existed when O2 was below 0450 L·min-1/m2 in CRF patients and it was called pathologic dependence of O2 on O2.On the other hand,the followup showed that all patients survived in the controls,but 8 out of 52 CRF patients died (135%),whose O2 ranged between 0222 to 0380 L·min-1/m2〔mean value:(0281±0047)L·min-1/m2〕.After treatment with ISD,MPAP and PVR declined from (470±080) kPa and (566±136) kPa·s/L to (330±040) kPa and (428±114)kPa·s/L respectively,while O2 increased form (0453±0164)L·min-1/m2 to (0506±0116)L·min-1/m2 (P<001) with no significant changes in PaO2 and CI.Conclusions:O2 and O2/O2 are reliable parameters to reflect the existence of tissue hypoxia in CRF patients,and may also be used as markers to determine the prognosis.In the critical care of CRF,efforts should not only be focused on oxygen therapy but also the decreased PVR to increase the oxygen supply to organs and tissues.
出处
《中国危重病急救医学》
CAS
CSCD
1998年第2期102-104,共3页
Chinese Critical Care Medicine
关键词
氧输送
氧消耗
呼吸衰竭
慢性
oxygen delivery oxygen consumption chronic respiratory failure
