急性高原病患者支气管肺泡灌洗前后肺功能及血气的改变

目的:探讨急性高原反应(HAAR)及高原肺水肿(HAPE)的发病机理。方法:对10例HAAR患者及6例HAPE患者灌洗前和灌洗后进行肺功能和动脉血气检测, 并与10例高原健康者进行对比。结果:HAAR患者及HAPE患者灌洗前动脉血氧分压明显低于对照组, HAAR同HAPE均存在弥散功能障碍;HAPE肺弥散功能(DLCO%)由灌洗前的(76.01±6.29)%, 上升到灌洗后的(103.31±9.23)%;气体转化因子(DLCO/VA%)由灌洗前的(150.30±15.20)%, 上升到灌洗后的(176.04±16.10)%;动脉血氧分压(PaO₂)由(31.73±3.01)mmHg上升到(45.31±3.56)mmHg。而HAAR及对照组灌洗后上述指标差异不显著。结论:HAPE患者肺泡内大量的液体渗出是HAPE病情恶化的主要原因之一。HAAR属HAPE发展的初级阶段, 存在着间质性肺水肿。

Changes of pulmonary function and partial oxygen pressure before and after bronchoalveolar lavage in patients with acute high altitude sickness

AIM:The purpose of this study was to evaluate the mechanism of high altitude pulmonary edema (HAPE) and high altitude acute response (HAAR).METHODS:Pulmonary function and partial oxygen pressure were measured in 10 patients with HAAR and 6 patients with HAPE before and after bronchoalveolar lavage (BAL), 10 high altitude healthy volunteers were served as control subjects.RESULTS:The partial oxygen pressure of HAAR and HAPE significantly decreased before BAL compared with control;DLCO%, DLCO/VA%, PaO₂ of HAPE increased significantly[from 76.01%±6.29%, 150.30%±15.20%, (31.73±3.01)mmHg before BAL to 103.31%9.23%, 176.04%16.10%, (45.31±3.56)mmHg after BAL].CONCLUSION:High concentration of proteins and cells in BAL fluid for HAPE, gas exchange impairment and PaO₂ increase after BAL suggeste accumulation of protein-rich fluid and cells in the alveolar space plays a crucial role in the development of HAPE.