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体外支气管过度充气可损害模拟呼吸时的支气管舒张作用,并增加对收缩激活的敏感性。

Hyperinflation of bronchi in vitro impairs bronchodilation to simulated breathing and increases sensitivity to contractile activation.

机构信息

School of Human Sciences, The University of Western Australia, Perth, WA, Australia.

Centre for Neonatal Research and Education, School of Paediatrics and Child Health, Perth, WA, Australia.

出版信息

Respirology. 2018 Aug;23(8):750-755. doi: 10.1111/resp.13271. Epub 2018 Feb 20.

Abstract

BACKGROUND AND OBJECTIVE

Lung hyperinflation and reduced bronchodilation to deep inspiration (DI) are features of chronic obstructive pulmonary disease (COPD). Hyperinflation might impair the ability of a DI to stretch airway smooth muscle (ASM), as the bronchi operate at a stiff region of the pressure-volume curve.

METHODS

Bronchial segments from pig lungs were mounted in an organ bath and equilibrated at either 5 cm H O (control) or 20 cm H O (hyperinflated) transmural pressure (P ). Cumulative dose-response curves to acetylcholine (ACh) were performed to determine maximal response (E ) and sensitivity under static conditions (fixed P ) or during simulated breathing (Δ10 cm H O P at 0.25 Hz). The effect of hyperinflation on ASM contraction was further examined in bronchial rings contracted at a short ASM length (reference length, L ) or stretched by an additional 30% (length 1.3 times the L , 1.3L ).

RESULTS

Oscillatory loads halved E from 61.0 ± 3.8 to 29.7 ± 4.4 cm H O (P < 0.0001) in control bronchial segments, but only from 40.0 ± 2.5 to 31.2 ± 2.4 cm H O (P < 0.05) in hyperinflated segments. The percentage reduction in active pressure with oscillation was less in hyperinflated compared with control segments (P < 0.01). Sensitivity was not altered by oscillation in either hyperinflated or control segments; however, hyperinflated segments were more sensitive (P < 0.05). The effect of inflation on sensitivity was confirmed using bronchial rings where stretched rings were more sensitive than unstretched rings (P < 0.01).

CONCLUSION

Hyperinflated bronchi exhibit reduced bronchodilation to breathing and increased sensitivity to bronchoconstrictor stimuli. Findings suggest that hyperinflation may directly alter airway function by reducing the protective effects of DI and initiating contraction at low doses of contractile stimuli.

摘要

背景和目的

肺过度充气和深吸气(DI)时支气管舒张减少是慢性阻塞性肺疾病(COPD)的特征。过度充气可能会损害 DI 拉伸气道平滑肌(ASM)的能力,因为支气管在压力-容积曲线上的僵硬区域工作。

方法

猪肺支气管段在器官浴中安装并在 5 cm H2O(对照)或 20 cm H2O(过度充气)跨壁压(P)下平衡。进行累积乙酰胆碱(ACh)剂量反应曲线以确定最大反应(E)和静态条件下的敏感性(固定 P)或模拟呼吸时的敏感性(0.25 Hz 时Δ10 cm H2O P)。进一步在支气管环收缩至较短的 ASM 长度(参考长度,L)或通过额外拉伸 30%(长度为 L 的 1.3 倍,1.3L)的情况下检查过度充气对 ASM 收缩的影响。

结果

在对照支气管段中,振荡负荷将 E 从 61.0±3.8 降至 29.7±4.4 cm H2O(P<0.0001),但在过度充气段中仅从 40.0±2.5 降至 31.2±2.4 cm H2O(P<0.05)。与对照段相比,过度充气段的主动压力随振荡的降低幅度较小(P<0.01)。振荡对超充气或对照段的敏感性没有改变;然而,超充气段更敏感(P<0.05)。通过使用拉伸环比未拉伸环更敏感的支气管环来确认充气对敏感性的影响(P<0.01)。

结论

过度充气的支气管表现出对呼吸的支气管舒张减少和对支气管收缩刺激的敏感性增加。研究结果表明,过度充气可能通过降低 DI 的保护作用并在低剂量收缩刺激下引发收缩来直接改变气道功能。

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