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快速输注生理盐水对人体肺力学和气道反应性的影响。

Effects of rapid saline infusion on lung mechanics and airway responsiveness in humans.

作者信息

Pellegrino Riccardo, Dellaca Raffaele, Macklem Peter T, Aliverti Andrea, Bertini Stefania, Lotti Pamela, Agostoni PierGiuseppe, Locatelli Alessandro, Brusasco Vito

机构信息

Fisiopatoloia Respiratoria, Azienda Ospedaliera S Croce e Carle, Cuneo.

出版信息

J Appl Physiol (1985). 2003 Aug;95(2):728-34. doi: 10.1152/japplphysiol.00310.2003. Epub 2003 May 2.

Abstract

Lung mechanics and airway responsiveness to methacholine (MCh) were studied in seven volunteers before and after a 20-min intravenous infusion of saline. Data were compared with those of a time point-matched control study. The following parameters were measured: 1-s forced expiratory volume, forced vital capacity, flows at 40% of control forced vital capacity on maximal (Vm(40)) and partial (Vp(40)) forced expiratory maneuvers, lung volumes, lung elastic recoil, lung resistance (Rl), dynamic elastance (Edyn), and within-breath resistance of respiratory system (Rrs). Rl and Edyn were measured during tidal breathing before and for 2 min after a deep inhalation and also at different lung volumes above and below functional residual capacity. Rrs was measured at functional residual capacity and at total lung capacity. Before MCh, saline infusion caused significant decrements of forced expiratory volume in 1 s, Vm(40), and Vp(40), but insignificantly affected lung volumes, elastic recoil, Rl, Edyn, and Rrs at any lung volume. Furthermore, saline infusion was associated with an increased response to MCh, which was not associated with significant changes in the ratio of Vm(40) to Vp(40). In conclusion, mild airflow obstruction and enhanced airway responsiveness were observed after saline, but this was not apparently due to altered elastic properties of the lung or inability of the airways to dilate with deep inhalation. It is speculated that it was likely the result of airway wall edema encroaching on the bronchial lumen.

摘要

在7名志愿者静脉输注生理盐水20分钟前后,对其肺力学和气道对乙酰甲胆碱(MCh)的反应性进行了研究。将数据与时间点匹配的对照研究数据进行比较。测量了以下参数:1秒用力呼气容积、用力肺活量、最大用力呼气动作(Vm(40))和部分用力呼气动作(Vp(40))时相当于对照用力肺活量40%时的流速、肺容积、肺弹性回缩力、肺阻力(Rl)、动态弹性阻力(Edyn)以及呼吸系统的呼吸内阻力(Rrs)。在深吸气前及深吸气后2分钟的潮气呼吸过程中,以及在功能残气量上下不同肺容积时测量Rl和Edyn。在功能残气量和肺总量时测量Rrs。在给予MCh之前,输注生理盐水导致1秒用力呼气容积、Vm(40)和Vp(40)显著下降,但对任何肺容积下的肺容积、弹性回缩力、Rl、Edyn和Rrs无显著影响。此外,输注生理盐水与对MCh的反应增加有关,这与Vm(40)与Vp(40)的比值无显著变化无关。总之,输注生理盐水后观察到轻度气流阻塞和气道反应性增强,但这显然不是由于肺弹性特性改变或气道在深吸气时不能扩张所致。推测这可能是气道壁水肿侵犯支气管腔的结果。

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