肺心病缓解期患者昼夜血液动力学、血气及血流变学的监测与临床观察

作者	单位
金维岳	上海市纺织工业局第二医院
虞家龙	上海市纺织工业局第二医院
汪秀娟	上海市纺织工业局第二医院
董宏法	上海市纺织工业局第二医院
费瑛	上海市纺织工业局第二医院
何德诚	上海市纺织工业局第二医院

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中文摘要:

对14例肺心病缓解期患者作了漂浮心导管检查,并于24小时内定期同步作肺动脉压、心排血量、动脉血气、经皮血气、血流变学等监测,结果显示 MPAP、PaCO₂、tcPCO₂、H、ηb、ηp等之平均值多以白天为低,晚上增高,而 CO、PaO₂、tcPO₂等测定值则相反。肺动脉高压纽患者 MPAP、CO、PaO₂、PaCO₂、tcPO₂、tcPCO₂测定值昼夜间波动比常压组患者更为显著（P<0.01）。昼夜间血流变学测定（H、ηb、ηp）结果显示,晚间血粘滞度增高更为明显。以上昼夜间各测定值的变化,有一定的规律性,似与中医"天人相应"观点相符,而其同步综合监测对本病的病情观察、抢救、预后估计等方面有一定的指导与参考作用。

英文摘要:

14 patients of cor putmonale in convalescent stage were studied with Swan-ganze catheter technique.The pulmonary arterial pressure,cardiac output,arterial blood gases,transcutaneous gases tension and hemorrheologic measurement were monitored simultaneously at definite intervals within 24 hours.The results showed that the mean value of the pulmonary arterial pressure（（?）PAP）, arterial carbon dioxide tension（PaCO₂）,transcutaneous carbon dioxide tension（tcPCO₂）, hematocrit（H）,whole blood viscosity（ηb）and plasma viscosity（ηp）were higher at night than those at daytime.While the value of cardiac output（CO）,arterial oxygen tension（PaO₂）and trans- cutaneous oxygen tension（tcPO₂）showed a converse result,most of them showed more predominant at daytime and tended to be lowered at night.The（?）PAP in some of convalescent patients might decrease to normal,but in the pulmonary hypertension group[（?）PAP≥2.66Kpa（20mmHg）]the day and night measurements of（?）PAP,CO,PaO₂,PaCO₂,tcPO₂,tcPCO₂ were fluctuate more obviously than in normal group（P<0.01）.The day and night hemorrheologic measurements such as H,ηb,ηp etc.showed that the blood viscosity increased more significantly at night than at daytime. The cardiac output（CO,CI）seemed to be a little bit lower in some patients especially in those with high pulmonary arterial pressure and at night.These results suggest that the variation of the day and night measurements of hemodynamics,blood gas,hemorrheotogic changes have some rule.Thus the combination of such monitoring procedures may play an important role for clinical observations and evaluation of the severity and prognosis of the disease,and may also be a considerable guide to the use of oxygen therapy,medical herbs of promoting blood circulation and removing stasis, anticoagulants and vasodilators.

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