Herzog H, Kopp C, Perruchoud A
Klin Wochenschr. 1977 Aug 15;55(16):777-86. doi: 10.1007/BF01651265.
First prophylactic and therapeutic possibilities in cor pulmonale are shown on the basis of its pathogenesis. Our own results illustrate the effect of therapy of the underlying lung disease and of the concomitant respiratory insufficiency on the pulmonary arterial hypertension. The relationship between pulmonary artery pressure (PAp), arterial oxygen tension, forced expiratory volume of 1 second (FEV1%VC) and slow inspired viral capacity (VC) is analysed. In obstructive respiratory disorders the PAp rises when FEV1 falls below 40% of VC, in restrictive disorders when VC falls below 70% of predicted rate. 27 patients with chronic obstructive lung disease were treated with bronchodilator aerosols by intermittent positive pressure breathing (IPPB) during 2 years after a control period of 2 years: VC and FEV1 improved, the increase of total lung capacity and the deterioration of arterial blood gases came to a halt. The elevated PAp was always significantly reduced by oxygen therapy or IPPB or the combination of both. Finally, the rationale for avoiding physical stress in established cor pulmonale is illustrated: in healthy men PAp increases by less than 20% when cardiac output is doubled. In patients with cor pulmonale PAp rises to three times the initial value under the same conditions.
基于肺心病的发病机制，展示了其最初的预防和治疗可能性。我们自己的研究结果说明了对潜在肺部疾病以及伴随的呼吸功能不全的治疗对肺动脉高压的影响。分析了肺动脉压（PAp）、动脉血氧张力、一秒用力呼气量（FEV1%VC）和慢肺活量（VC）之间的关系。在阻塞性呼吸障碍中，当FEV1降至VC的40%以下时PAp升高，在限制性障碍中，当VC降至预测值的70%以下时PAp升高。27例慢性阻塞性肺疾病患者在经过2年的对照期后，通过间歇正压通气（IPPB）使用支气管扩张剂气雾剂治疗2年：VC和FEV1有所改善，肺总量增加和动脉血气恶化停止。通过氧疗或IPPB或两者联合，总是能显著降低升高的PAp。最后，阐述了在已确诊的肺心病中避免身体应激的基本原理：在健康男性中，当心输出量加倍时，PAp升高不到20%。在肺心病患者中，在相同条件下PAp会升至初始值的三倍。
