NHLI Cardiovascular Sciences, Imperial College London, London, UK NHLI Respiratory Sciences, Imperial College London, London, UK Imperial College School of Medicine, Imperial College London, London, UK.
NHLI Cardiovascular Sciences, Imperial College London, London, UK Imperial College School of Medicine, Imperial College London, London, UK.
Thorax. 2014 Nov;69(11):1046-7. doi: 10.1136/thoraxjnl-2014-205289. Epub 2014 Apr 8.
Postural changes in 258 patients with pulmonary arteriovenous malformations (PAVMs) reviewed between 2005 and 2013 were evaluated prospectively using validated pulse oximetry methods. Of the 257 completing the test, 75 (29%) demonstrated orthodeoxia with an oxygen saturation fall of at least 2% on standing. None described platypnoea (dyspnoea on standing). The heart rate was consistently higher in the erect posture: 74 (29%) had a postural orthostatic tachycardia of ≥20 min(-1), and in 25 (10%) this exceeded 30 min(-1). Orthostatic tachycardia was more pronounced in PAVM patients than controls without orthodeoxia (age-adjusted coefficient 5.5 (95% CIs 2.6, 8.4) min(-1), p<0.001). For PAVM patients, the age-adjusted pulse rise was 0.79 min(-1) greater for every 1% greater drop in oxygen saturation on standing (p<0.001). In contrast to the postural orthostatic tachycardia syndrome, in this population, there was a trend for more pronounced orthostatic tachycardia to be associated with better exercise tolerance.
2005 年至 2013 年期间，前瞻性地使用经过验证的脉搏血氧测定法评估了 258 例肺动静脉畸形（PAVM）患者的体位变化。在完成测试的 257 例患者中，75 例（29%）存在直立性低氧血症，即站立时氧饱和度下降至少 2%。无患者描述出现类立人呼吸（直立时呼吸困难）。直立位时心率始终较高：74 例（29%）存在体位性心动过速，至少增加 20 次/分钟，25 例（10%）超过 30 次/分钟。与无直立性低氧血症的对照组相比，PAVM 患者的直立性心动过速更为明显（年龄调整后系数为 5.5（95%CI 2.6，8.4）次/分钟，p<0.001）。对于 PAVM 患者，站立时氧饱和度每下降 1%，脉搏增加 0.79 次/分钟（p<0.001）。与直立位心动过速综合征不同，在该人群中，更明显的直立性心动过速与更好的运动耐量呈正相关趋势。
