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[慢性支气管肺炎伴呼吸功能不全的继发性红细胞增多症及气体分析变化]

[Secondary polycythemia and gasometric changes in chronic bronchopneumopathies with respiratory insufficiency].

作者信息

Sánchez Sánchez M L, Plaza Hurtado R, Delgado Herreros N, Rubio Pérez P

出版信息

An Med Interna. 1989 Nov;6(11):567-70.

PMID:2562697
Abstract

42 patients with chronic bronchopneumopathy were divided into 2 groups: one with polyemia (15 patients) and the other without polyemia (27 patients). There was no statistical significant differences in median age, clinical evolution nor basal medium arterial PO2 value (43 +/- 12 and 48 +/- 11 mm Hg); while there was an increase of median basal PCO2 in patients with polyemia (54 +/- 8.4 and 48 +/- 9.3; P < 0.025). There was direct correlation between PCO2 and Hb levels in the whole series (r = 0.42; P < 0.01) and equal correlation in the limit of statistical signification between PCO2 and red cells (r = 0.29; P = 0.05). The correlation between these hematic values and the PO2 values of the whole series was not significant, this taking into account the logical inverse relation between them, because of the important role of hypoxia in developing polyemia. The correlation between PO2 and PCO2 was inverse and significant (r = -0.33; P < 0.05). These findings show the apparent influence of CO2 retention to produce polyemia, apart from the effects of hypoxia, being the opposite of the results in experimental studies which showed a stoppage of the erythropoietin production by CO2 effects. The probable explanation is that patients with more PCO2 had more intense respiratory malfunction than lower PCO2 patients, producing night episodes of more basal hypoxia, this being a major stimulus of polyemia.

摘要

42例慢性支气管肺病患者被分为两组:一组为红细胞增多症患者(15例),另一组为无红细胞增多症患者(27例)。两组患者在年龄中位数、临床病程以及基础平均动脉血氧分压值方面均无统计学显著差异(分别为43±12和48±11 mmHg);而红细胞增多症患者的基础二氧化碳分压中位数有所升高(分别为54±8.4和48±9.3;P<0.025)。在整个研究系列中,二氧化碳分压与血红蛋白水平之间存在直接相关性(r = 0.42;P<0.01),在二氧化碳分压与红细胞之间的相关性在统计学意义临界值时相同(r = 0.29;P = 0.05)。考虑到这些血液学指标与整个系列的血氧分压值之间存在逻辑上的反比关系,且缺氧在红细胞增多症发生中起重要作用,所以这些血液学指标与血氧分压值之间的相关性并不显著。血氧分压与二氧化碳分压之间呈反比且具有显著相关性(r = -0.33;P<0.05)。这些发现表明,除了缺氧的影响外,二氧化碳潴留对红细胞增多症的产生具有明显影响,这与实验研究结果相反,实验研究表明二氧化碳会抑制促红细胞生成素的产生。可能的解释是,二氧化碳分压较高的患者比二氧化碳分压较低的患者呼吸功能障碍更严重,导致夜间基础缺氧更严重,而这是红细胞增多症的主要刺激因素。

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