Delage A, Marquette C-H
Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, France.
Rev Mal Respir. 2009 Dec;26(10):1118-26. doi: 10.1016/s0761-8425(09)73538-7.
In late stage chronic obstructive pulmonary disease, emphysema can worsen respiratory symptoms not only via the loss of surface for gas exchange but also via alterations in mechanical properties of the respiratory system (dynamic and static hyper-inflation). Emphysematous lung volume reduction aims at improving respiratory mechanics and symptomatology in patients with advanced emphysema. Lung volume reduction surgery (LVRS) has been shown to be effective in selected patient populations but its morbidity and costs are quite elevated. Alternatives to LVRS do not remove emphysematous lung tissue per say but rather consist of devices aiming to: 1) reduce the volume that affected lung parenchyma occupies (unidirectional endobronchial valves or plugs, parenchymal injection of bioactive scarring agents); 2) redistribute ventilatory flow (airway bypass systems). Preliminary studies of these devices have shown that they are relatively safe. These also show modest benefit in exercise capacity, although individual subjects can experience spectacular improvement. Current objective is to identify predictors of response to therapy with such devices.
在晚期慢性阻塞性肺疾病中，肺气肿不仅可通过气体交换表面的丧失，还可通过呼吸系统机械性能的改变（动态和静态过度充气）加重呼吸症状。肺气肿肺容积减少旨在改善晚期肺气肿患者的呼吸力学和症状。肺减容手术（LVRS）已被证明在特定患者群体中有效，但其发病率和成本相当高。LVRS的替代方法并非直接去除肺气肿肺组织，而是由旨在：1）减少受影响肺实质所占容积（单向支气管内瓣膜或栓子、实质内注射生物活性瘢痕形成剂）；2）重新分配通气气流（气道旁路系统）的装置组成。对这些装置的初步研究表明它们相对安全。这些装置在运动能力方面也显示出适度的益处，尽管个别受试者可能会有显著改善。当前的目标是确定对此类装置治疗反应的预测因素。
