Hospital of The Rockefeller Institute for Medical Research, New York.
J Exp Med. 1913 Jul 1;18(1):7-17. doi: 10.1084/jem.18.1.7.
In most cases of uncomplicated lobar pneumonia the decrease of respiratory surface is completely compensated for, and the oxygen content of the blood is within normal limits. Occasional cases of uncomplicated pneumonia have an oxygen content of the venous blood which is below normal. In the two cases reported here, this was associated with a carbon dioxide content of the blood which was higher than normally, and the condition was apparently due to an interference with the respiratory exchange of gases. In the terminal stage of the fatal cases of pneumonia in which death does not occur with great suddenness, there is often a progressive diminution in the oxygen content of the blood. Synchronous with this is a progressive decrease in the oxygen-combining capacity of the blood. These changes are usually seen in patients in whom an intense bacteremia has developed and are analogous to those found in the arterial blood of infected rabbits, and to those resulting from the growth of the pneumococcus in blood in vitro. In all three conditions there is probably a change of oxyhemoglobin to methemoglobin. This change of the hemoglobin molecule, so that it no longer takes up and gives off oxygen readily, is probably a factor in the immediate cause of death in many cases of pneumonia.
在大多数单纯性大叶性肺炎病例中，呼吸表面的减少得到了完全补偿，血液中的氧含量处于正常范围内。偶尔有一些单纯性肺炎病例的静脉血氧含量低于正常水平。在本文报道的两个病例中，这与血液中二氧化碳含量高于正常水平有关，这种情况显然是由于气体交换受到干扰所致。在肺炎的终末期，死亡并非突然发生，血液中的氧含量通常会逐渐下降。与之同步的是血液氧结合能力的逐渐下降。这些变化通常见于发生强烈菌血症的患者，与感染兔的动脉血液中的变化以及体外肺炎球菌在血液中生长的变化类似。在所有这三种情况下，可能都存在氧合血红蛋白向高铁血红蛋白的变化。血红蛋白分子的这种变化，使其不再容易摄取和释放氧气，可能是许多肺炎病例中死亡的直接原因之一。
