Exercise induced pulmonary vasoconstriction.
Exercise induced pulmonary vasoconstriction.
复制标题
运动引起的肺血管收缩。
作者：
Thomas J. Kulik;John L. Bass;Bradley P. Fuhrman;James H. Moller;James E. Lock
运动期间肺血管阻力通常会下降或保持不变，或者福尔斯。对7例肺动脉高压患儿进行了室间隔缺损（6例）和动脉干（1例）手术矫正后心导管插入期间的运动。除中度肺动脉高压外，这7名儿童的静息血流动力学与同龄正常儿童相似，但在运动期间，术后患者的总肺血管阻力增加而不是下降（+2% vs -18%）。7名儿童中有两名在运动过程中肺小动脉阻力大幅增加（一名患者从509到715达因·cm-5，另一名患者从606到828达因·cm-5）。这两名患者在运动时动脉或混合静脉血氧饱和度或pH值方面与正常儿童无差异，左心房压也与肺阻力升高无关。然而，这两名患者在运动期间心输出量仅小幅增加（6.8%和43.1%），尽管耗氧量大幅增加（121%和373%）。其中一名患有运动性肺血管收缩的患者在第一次运动研究后的五年内，静息肺血管阻力增加了82%。对这些数据和先前报告的数据进行分析，表明运动诱发的肺血管收缩可能发生在10%至25%的某些先天性心脏缺陷矫正后存活的患者中。血管收缩不能归因于血气或左房压的异常变化，可能是进行性肺动脉高压的早期体征。
Pulmonary vascular resistance normally falls or remains unchanged during exercise. Seven children with pulmonary hypertension were exercised during cardiac catheterisation after operative correction of ventricular septal defect (6) and truncus arteriosus (1). Except for the presence of moderate pulmonary hypertension, resting haemodynamics in these seven children were similar to those of normal children of equal age, but during exercise the postoperative patients showed a rise rather than a fall (+2% vs -18%) in total pulmonary vascular resistance. Two of the seven children had a substantial increase in pulmonary arteriolar resistance during exercise (from 509 to 715 dyne s cm-5 in one patient and from 606 to 828 dyne s cm-5 in the other). These two patients did not differ from normal children in respect of arterial or mixed venous oxygen saturations or of pH with exercise, nor was left atrial pressure related to the rise in pulmonary resistance. These two patients, however, had only a small rise in cardiac output during exercise (6.8% and 43.1%) in spite of a substantial increase in oxygen consumption (121% and 373%). One of the patients with exercise-induced pulmonary vasoconstriction had an 82% increase in resting pulmonary vascular resistance over a five year period subsequent to her first exercise study. Analysis of these data, and those previously reported, suggests that exercise induced pulmonary vasoconstriction may occur in 10 to 25% of patients who survive correction of certain congenital cardiac defects. The vasoconstriction cannot be attributed to abnormal changes in blood gases or left atrial pressure, and may be an early sign of progressive pulmonary hypertension.