Adebahr G
Institut für Rechtsmedizin, Universität Essen-GHS, Bundesrepublik Deutschland.
Z Rechtsmed. 1988;100(1):55-64. doi: 10.1007/BF00200364.
The functional and nutritive circulation in the lungs is connected by anastomoses between the pulmonary and bronchial arteries. The anastomoses have the structure of blocked arteries from which arteriovenous anastomoses proceed to the peribronchial plexus. The pulmonary artery is provided with a flow impulse by the anastomoses, and oxygen-containing blood is admixed with the venous blood, thus forming an "aortalization" in the lungs. By diverting the bloodstream, venous blood can reach the bronchial artery. The peculiarities of the lung circulation are important for vital reactions in the form of macro- and microembolisms. Macroembolisms prove the functionality of the system if branches of the pulmonary artery are closed before the arteries are blocked. A hemorrhagic infarction either arises or does not arise, and the hemorrhagic infarction cannot exceed a certain limit. A microembolism is over and above the anastomoses. If the microembolism is greater, pressure in the arteria pulmonaris can cause blood from the pulmonary artery to overflow into the bronchial artery. Because arteriovenous anastomoses arise from the blocked arteries, microemboli can now reach the systemic circulation. Thus, the system described can explain the passage of microemboli into the systemic circulation, avoiding the capillaries of the lungs; on the other hand, larger microembolisms can prove the functionality of the system.
肺内的功能性循环和营养性循环通过肺动脉和支气管动脉之间的吻合支相连。这些吻合支具有闭锁动脉的结构,动静脉吻合支从闭锁动脉延伸至支气管周围丛。吻合支为肺动脉提供血流冲动,含氧血液与静脉血混合,从而在肺内形成“主动脉化”。通过改变血流方向,静脉血可到达支气管动脉。肺循环的这些特点对于宏观和微观栓塞形式的生命反应很重要。如果肺动脉分支在动脉阻塞前关闭,宏观栓塞可证明该系统的功能。会出现或不出现出血性梗死,且出血性梗死不会超过一定限度。微观栓塞存在于吻合支之外。如果微观栓塞较大,肺动脉压力可导致肺动脉血液溢流至支气管动脉。由于动静脉吻合支源自闭锁动脉,微观栓子现在可进入体循环。因此,所描述的系统可以解释微观栓子避开肺毛细血管进入体循环的过程;另一方面,较大的微观栓塞可证明该系统的功能。