PULMONARY-ARTERY HEMODYNAMICS IN PRIMARY PULMONARY-HYPERTENSION
PULMONARY-ARTERY HEMODYNAMICS IN PRIMARY PULMONARY-HYPERTENSION
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DOI：
10.1016/0735-1097(93)90682-q
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发表时间：
1993-02-01
影响因子：
24
通讯作者：
KUSSMAUL, WG
中科院分区：
文献类型：
--
作者：
LASKEY, WK;FERRARI, VA;KUSSMAUL, WG
目标。本研究比较和对比了原发性肺动脉高压患者和正常对照者静息和运动时的稳定期和搏动性肺血流动力学。一个完整的描述压力和流量之间的关系在肺循环包括稳定和脉动的血液动力学行为。原发性肺动脉高压患者提供了一个独特的机会来研究原发性肺血管改变对肺动脉血管水力负荷的影响。采用8例原发性肺动脉高压患者和10例对照者的肺动脉导管尖端压力和速度记录，得到静息和运动时肺动脉输入阻抗谱和脉搏波反射程度。正如预期的那样，原发性肺动脉高压患者的平均肺动脉压（50 +/- 10 mm Hg）和肺血管阻力（880 +/- 446 dys）。cm-5)在休息时明显升高，在运动期间保持不变（平均压力71 +/- 15 mm Hg，平均阻力750 +/-530 dynes）。S.CM-5)。肺动脉特征阻抗在休息时升高，不随运动而改变（休息55 +/- 25 dys .cm-5；运动66 +/- 33 dys .cm-5）。动脉波反射测量显示原发性肺动脉高压患者静息时肺床波反射范围大（反射系数0.89 +/- 0.09），复合反射波在右心室射血中段到达。虽然波反射的程度随运动而降低（反射系数0.81 +/- 0.10,p < 0.05），但这些反射的幅度和时间仍然不利。此外，在原发性肺动脉高压患者中，运动后的脑卒中容量反应与肺动脉舒张压、肺血管阻力和反射因子的静息水平密切相关，而在对照组中没有发现这种关系。除了原发性肺动脉高压患者静息时肺动脉血流动力学稳定测量的预期异常外，静息和运动时振荡行为（特征阻抗和脉搏波反射）的测量也受到干扰。稳定和脉动行为的测量，特别是波反射，似乎在这些患者的运动反应中起着重要作用。
Objectives. The present investigation compared and contrasted steady and pulsatile pulmonary hemodynamics at rest and during exercise in patients with primary pulmonary hypertension and normal control subjects.Background. A complete description of the relation between pressure and flow in the pulmonary circulation includes both steady and pulsatile hemodynamic behavior. Patients with primary pulmonary hypertension provide a unique opportunity to study the effects of primary alterations in pulmonary vasculature on pulmonary artery vascular hydraulic load.Methods. Catheter tip pressure and velocity recordings from the main pulmonary artery in 8 patients with primary pulmonary hypertension and 10 control subjects were used to derive the pulmonary artery input impedance spectrum and the extent of pulse wave reflection at rest and during exercise.Results. As expected, in patients with primary pulmonary hypertension, mean pulmonary artery pressure (50 +/- 10 mm Hg) and pulmonary vascular resistance (880 +/- 446 dynes.s.cm-5) were markedly elevated at rest and remained so during exercise (mean pressure 71 +/- 15 mm Hg, mean resistance 750 +/-530 dynes. S.CM-5). Pulmonary artery characteristic impedance was elevated at rest and did not change with exercise (rest 55 +/- 25 dynes.s.cm-5; exercise 66 +/- 33 dynes.s-cm-5). Measures of arterial wave reflection indicated that the extent of wave reflection in the pulmonary bed in those with primary pulmonary hypertension is large at rest (reflection coefficient 0.89 +/- 0.09) and that the composite reflected wave arrived during the midportion of right ventricular ejection. Although the extent of wave reflection decreased with exercise (reflection coefficient 0.81 +/- 0.10, p < 0.05), the magnitude and timing of these reflections remained adverse. Furthermore, in patients with primary pulmonary hypertension, the stroke volume response to exercise was strongly related to rest levels of pulmonary artery diastolic pressure, pulmonary vascular resistance and the reflection factor, whereas no such relation was found in the control subjects.Conclusions. In addition to the expected abnormalities in steady measures of pulmonary artery hemodynamics at rest in patients with primary pulmonary hypertension, rest and exercise measures of oscillatory behavior (characteristic impedance and pulse wave reflection) are perturbed. Measures of steady and pulsatile behavior, particularly wave reflection, appear to have an important role in the exercise response of these patients.