Alpert M A, Bauer J H, Parker B M, Sanfelippo J F, Brooks C S
South Med J. 1985 Jul;78(7):784-9. doi: 10.1097/00007611-198507000-00006.
We reviewed cardiac catheterization data and the medical records of 30 patients with systemic hypertension to establish their pulmonary hemodynamic profiles and the relationship between certain clinical and demographic variables and increased pulmonary vascular resistance. Mean systemic arterial pressure ranged from 110 to 210 mm Hg, and systemic vascular resistance ranged from 17.6 to 47.0 units. Seven patients had normal pulmonary wedge pressure and normal pulmonary vascular resistance, one had elevated pulmonary wedge pressure and normal pulmonary vascular resistance, five had elevated pulmonary wedge pressure and increased pulmonary vascular resistance, and 17 had normal pulmonary wedge pressure and increased pulmonary vascular resistance. There were significant positive correlations between systemic vascular resistance and pulmonary vascular resistance and between mean systemic arterial pressure and mean pulmonary artery pressure, but there was no correlation between mean pulmonary wedge pressure and pulmonary vascular resistance. Of the 17 patients with normal pulmonary wedge pressure and increased pulmonary vascular resistance, seven had clinical or radiologic evidence of prior left ventricular failure. We conclude that increased pulmonary vascular resistance occurs commonly in patients with systemic hypertension. Although some cases of increased pulmonary vascular resistance relate to active or preexistent left ventricular failure, the majority remain unexplained, suggesting that neurohumoral or other factors may produce a hypertensive response in both the systemic and pulmonary arterial circuit.
我们回顾了30例系统性高血压患者的心脏导管检查数据和病历，以确定他们的肺血流动力学特征，以及某些临床和人口统计学变量与肺血管阻力增加之间的关系。平均体循环动脉压范围为110至210毫米汞柱，体循环血管阻力范围为17.6至47.0单位。7例患者肺楔压正常且肺血管阻力正常，1例肺楔压升高但肺血管阻力正常，5例肺楔压升高且肺血管阻力增加，17例肺楔压正常但肺血管阻力增加。体循环血管阻力与肺血管阻力之间、平均体循环动脉压与平均肺动脉压之间存在显著正相关，但平均肺楔压与肺血管阻力之间无相关性。在17例肺楔压正常但肺血管阻力增加的患者中，7例有既往左心室衰竭的临床或影像学证据。我们得出结论，肺血管阻力增加在系统性高血压患者中很常见。虽然一些肺血管阻力增加的病例与活动性或既往存在的左心室衰竭有关，但大多数病例仍无法解释，这表明神经体液或其他因素可能在体循环和肺循环动脉中产生高血压反应。
