肺心病Ⅱ型呼衰合并高粘血症表现有四个特点:①高血液粘度;②高血液浓稠性;③高红细胞聚集性;④低红细胞变形性。其中,血液的高粘度是后三者的总结果,而后三者是高粘血症的不同表现形式。这些血液流变学特性,则在不同管径、不同流速、不同驱动压的不同节段的血管中,影响着血液的粘度及血流阻力。例如:红细胞的高聚集性主要在低切速的血流中使血液粘度升高,因此静脉中红细胞的高聚性不利于血流中红细胞的均匀分散,而有增加血液粘度及血流阻力的作用。红细胞的低变形性主要影响血液通过微循坏的微血管。血液的高浓稠性则无论切速高低,都可使血液粘度增加,血流阻力升高。血液粘度增高后,可以通过以下四个环节加重呼衰和病情:①血液粘度增加,使大循坏、肺动脉阻抗升高,增加心脏后负荷,使心脏指数下降,心衰加重。②血液粘度增加,可以导致脑血流量下降,促使肺脑的发生。⑤红细胞的高聚性,增加了静脉系统的回流阻力,在右心衰的情况下,便可加重组织淤血;同时,红细胞的低变形性影响了微循环的血流,加重了微循环灌注不足。④血液高浓稠性(血球压积异常升高)降低了红细胞的携氧能力;肺微循环中红细胞的低变形性,严重地影响了肺摄氧能力。高粘血症的诊断,依据血液流变学的测定,通 Pulmonary heart disease type Ⅱ respiratory failure with hyperviscosity manifestations have four characteristics: ① high blood viscosity; ② high blood thickening; ③ high erythrocyte aggregation; ④ low erythrocyte deformability. Among them, the high viscosity of the blood is the total of the latter three, and the latter three are different manifestations of hyperviscosity. These hemorheological properties affect blood viscosity and blood flow resistance in different segments of blood vessels with different diameters, different flow rates and different driving pressures. For example, the high aggregation of erythrocytes mainly results in the increase of blood viscosity in the low-shear blood flow. Therefore, the aggregation of red blood cells in the veins is not conducive to the uniform dispersion of erythrocytes in the blood stream, but also increases the blood viscosity and blood flow resistance effect. Low deformability of erythrocytes mainly affects blood flow through the microcirculation microvessels. High blood viscosity regardless of the high and low, can increase blood viscosity, increased blood flow resistance. After the blood viscosity is increased, the respiratory failure can be aggravated by the following four steps: (1) blood viscosity increases, causing great damage, increased pulmonary artery impedance, increased cardiac afterload, heart index decreased, increased heart failure. ② increased blood viscosity, can lead to decreased cerebral blood flow, promote the occurrence of pulmonary brain. ⑤ high aggregation of red blood cells, an increase of venous system reflux resistance, in the case of right heart failure, can increase tissue congestion; the same time, the low deformability of red blood cells affect the microcirculation of blood flow, increased microcirculation perfusion . ④ high blood concentration (abnormally elevated hematocrit) reduce the oxygen carrying capacity of red blood cells; red blood cells in the microcirculation of low deformability, seriously affecting lung oxygen capacity. Diagnosis of hyperviscosity, based on the determination of hemorheology, pass