医学
肺减容手术
肺移植
慢性阻塞性肺病
肺
血流动力学
还原(数学)
肺容量减少
肺容积
心脏病学
重症监护医学
内科学
几何学
数学
作者
Gabriel Thabut,Gaëlle Dauriat,Jean Baptiste Stern,Damien Logeart,Antoine Lévy,Rolana Marrash-Chahla,Hervé Mal
出处
期刊:Chest
[Elsevier]
日期:2005-05-01
卷期号:127 (5): 1531-1536
被引量:435
标识
DOI:10.1378/chest.127.5.1531
摘要
Study objectives To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT). Design Retrospective study. Setting One center in France. Patients Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT. Results Mean age was 54.6 years. Pulmonary function test results were as follows: FEV1, 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to Pao2 and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV1, 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao2, 46.2 mm Hg). Conclusion While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators. To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT). Retrospective study. One center in France. Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT. Mean age was 54.6 years. Pulmonary function test results were as follows: FEV1, 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to Pao2 and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV1, 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao2, 46.2 mm Hg). While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators.
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