【摘要】 目的探讨慢性肺源性心脏病(简称肺心病)急性加重期氧代谢变化。方法采用自身对照方法,选择30例肺心病患者,在急性加重期及缓解期分别测定血流动力学、PaO2、氧输送(D·O2)、氧耗量(V·O2)、动静脉血氧含量差C(a--v)O2、红细胞滤过指数(IF)及2,3-二磷酸甘油酸(2,3-DPG)含量,比较其差异并进行相关性分析。结果①肺心病急性加重期与缓解期D·O2分别为(397±142)mL·min-1·m-2和(617±183)mL·min-1·m-2,有显著性差异(P<0·01)。在急性加重期D·O2与V·O2呈正相关(r=0·59,P<0·01),在缓解期无明显相关性(P>0·05)。②急性期与缓解期C(a-v-)O2分别为(5·59±1·6)mL/dL和(3·05±1·07)mL/dL,有显著性差异(P<0·01)。③急性期IF升高,红细胞内2,3-DPG降低,与缓解期比较有显著性差异(P<0·01)。结论肺心病急性加重期存在病理性氧供依赖关系,周围组织存在氧摄取与利用障碍。红细胞内2,3-DPG减少及红细胞变形能力下降,可能加重微循环障碍,降低氧释放能力。更多还原

【Abstract】 Objective To explore the changes of oxygen metabolism in patients with acute exacerbation of cor pulmonale.Methods Thirty patients with acute exacerbation of cor pulmonale due to chronic obstructive pulmonary disease（COPD） were enrolled in the study using self-control method.Parameters including haemodynamics,PaO₂,oxygen delivery（D·O₂）,oxygen consumption（V·O₂）,arterial blood oxygen content（CaO₂）,mixed venous oxygen content（CO₂）,erythrocyte filterability index（IF） and content of erythrocyte 2,3-diphosphoglyceric acid（2,3-DPG） were measured and compared before and after remission.Results （1）There was significant difference in D·O₂ before and after remission （379±142）mL·min -1 ·m -2 vs （617±183） mL·min -1 ·m -2 , P<0.01 .A positive correlation was found between D·O₂ and V·O₂ in acute exacerbation phase（r=0.59,P<0.01）,but not found in stable phase（P>0.05）.（2） C （a-） O₂ in acute exacerbation and stable phases were （5.59±1.6）mL/dL and （3.05±1.07）mL/dL,respectively,with remarkable difference found（P<0.01）.（3）IF was remarkably elevated and 2,3-DPG was remarkably lowered in acute exacerbation phase compared to those in stable phase（both P<0.01）.Conclusions Patients with acute exacerbation of chronic cor pulmonale show a pathological dependence of V·O₂ on D·O₂ implying a pathological oxygen supply dependence.The decline of oxygen delivery might be attributed to the decrease content of 2,3-DPG in erythrocyte along with decreased cell deformation capacity.更多还原