Suresh Karthik, Shimoda Larissa A
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Compr Physiol. 2016 Mar 15;6(2):897-943. doi: 10.1002/cphy.c140049.
The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed.
肺循环在容量和功能方面都很独特。例如,它是唯一具有两种循环的器官:肺循环,其主要功能是气体交换;支气管循环,一种体循环血管供应,为传导气道、肺动脉和静脉壁提供含氧血液。肺循环容纳了整个心输出量,在低血管内动脉压下维持高血流量。与体循环相比,肺动脉壁更薄,血管平滑肌少得多,且相对缺乏基础张力。控制肺血流的因素包括血管结构、重力、呼吸的机械作用以及神经和体液因素的影响。缺氧也会改变肺血管张力,导致肺血管收缩。如果缺氧刺激持续很长时间,血管收缩会伴随着血管重塑,导致肺动脉高压。此外,遗传和环境因素也会使人易患肺动脉高压。在正常情况下,内皮形成紧密屏障,积极调节间质液稳态。感染和炎症会破坏正常的屏障稳态,导致通透性增加和水肿形成。本文重点回顾肺循环(肺循环和支气管循环)的基础知识、出生时的正常发育和转变以及血管调节。还将讨论导致肺循环病理状况的机制,特别是当屏障功能受损以及肺动脉高压发展过程中的机制。