高原肺水肿患者血流动力学变化研究

背景　高原肺水肿（HAPE）是一种严重危及生命的急性高原病，近年来对其研究越来越广泛，临床治疗效果也在不断提高。虽然国内有对HAPE患者应用有创血流动力学监测的相关研究，但报道的病例不多，对其监测的心脏指标有限，且目前国内尚未见关于HAPE患者应用无创血流动力学、流量、心脏前后负荷监测指标的研究。目的　探讨HAPE患者血流动力学的变化，为HAPE的治疗提供理论依据。方法　随机选择青海省交通医院急救中心2016年2月-2019年10月收治的HAPE患者22例为HAPE组，20名健康志愿者为对照组。对HAPE组治疗前、治愈后及对照组进行pH值、血氧饱和度（SaO2）、二氧化碳分压（PaCO2）、血乳酸（Lac）、心率（HR）、每分输出量（CO）、心指数（CI）、每搏输出量（SV）、总外周血管阻力（TPR）、总外周血管阻力指数（TPRI）、每分输出量绝对值（△CO）、每搏输出量绝对值（△SV）、下腔静脉宽度、下腔静脉呼吸变异度检测，同时对HAPE组治疗前及治愈后行中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）、静动脉血二氧化碳分压差（Pcv-aCO2）监测。结果　HAPE组治疗前pH值、Lac高于对照组，SaO2、PaCO2低于对照组（P<0.05）。HAPE组治疗前HR、TPR、TPRI、下腔静脉宽度大于对照组，CO、CI、SV、△CO、△SV、下腔静脉呼吸变异度小于对照组（P<0.05）。HAPE组治愈后HR、CO、CI、SV、TPR、TPRI、△CO、△SV、下腔静脉宽度、下腔静脉呼吸变异度与对照组比较，差异均无统计学意义（P>0.05）。HAPE组治愈后HR、TPR、TPRI、下腔静脉宽度、CVP、Pcv-aCO2小于治疗前，CO、CI、SV、△CO、△SV、下腔静脉呼吸变异度、ScvO2大于治疗前（P<0.05）。结论　HAPE患者心脏前后负荷增加，导致心力衰竭的发生，血流动力学表现为心输出量下降，外周血管阻力增高。

Hemodynamic Changes in Patients with High-altitude Pulmonary Edema

Background　High-altitude phlmonary edema（HAPE）is a severe acute altitude illness that potentially threatens the life，which is increasingly studied，and the treatment outcome of it is getting better．In China，there are studies on invasive hemodynamic monitoring of HAPE，with rare cases and limited cardiac indices，but there are no studies about non-invasive hemodynamic monitoring，blood flow，cardiac preload and afterload of HAPE cases．Objective　To study the hemodynamic changes of patients with HAPE，providing a theoretical basis for the treatment of this disease．Methods　Twenty-two patients with HAPE were selected from Emergency Medical Center，Qinghai Provincial Traffic Hospital from February 2016 to October 2019，and were compared with 20 healthy volunteers living in the local area．Indices such as serum pH value，oxygen saturation（SaO2），partial pressure of carbon dioxide（PaCO2），lactic acid（Lac），heart rate（HR），cardiac output（CO），cardiac index（CI），stroke volume（SV），total peripheral resistance（TPR），TPR index，absolute value of CO（△CO），absolute value of stroke volume（△SV），inferior vena caval diameter，and inferior vena cava respiratory variability of the control group were compared with pre-and post-treatment levels of these indices of HAPE group．Central venous pressure（CVP），central venous oxygen saturation（ScvO2），and central venous-to-arterial partial pressure of carbon dioxide difference（Pcv-aCO2）in HAPE group were compared before and after treatment．Results　Compared with the control group，pre-treated HAPE group had higher average serum pH value and Lac，and lower average SaO2 and PaCO2（P<0.05）．Moreover，pre-treated HAPE group had greater average HR，TPR，TPR index and inferior vena caval diameter and less average CO，CI，SV，△CO，△SV and inferior vena cava respiratory variability（P<0.05）．Post-treated HAPE group showed similar levels of HR，CO，CI，SV，TPR，TPR index，△CO，△SV，inferior vena caval diameter and inferior vena cava respiratory variability to the control group（P>0.05）．Compared to baseline，post-treatment levels of HR，TPR，TPR index and inferior vena caval diameter decreased，and CO，CI，SV，△CO，△SV and inferior vena cava respiratory variability increased in the HAPE group（P<0.05）．Moreover，post-treatment levels of CVP and Pcv-aCO2 decreased and ScvO2 increased in the HAPE group（P<0.05）．Conclusion　The increased cardiac preload and afterload may lead to heart failure in HAPE patients with hemodynamic manifestations of reduced CO and increased peripheral vascular resistance．