Banner N R, Heaton R, Hollingshead L, Guz A, Yacoub M H
Cardiothoracic Unit, Harefield Hospital, Middlesex.
Thorax. 1988 Dec;43(12):955-9. doi: 10.1136/thx.43.12.955.
The operation of combined heart-lung transplantation results in acute denervation of the heart, lungs, and airways below the level of the trachea. The bronchoconstrictor response to inhaled methacholine of 12 recipients of heart-lung transplants was compared with that of 12 recipients of heart transplants having similar medication and 12 normal subjects. The median dose of methacholine that produced a reduction of at least 20% in the FEV1 (PC20) for the recipients of heart-lung transplants (8 mg/ml) was significantly lower than that for the recipients of heart transplants (64 mg/ml) and normal subjects (greater than 64 mg/ml). The increased airway reactivity may be related to the effects of chronic pulmonary denervation or subclinical inflammation in the airways. The effect of denervation on the response to full inspiration during bronchoconstriction was studied in six patients with heart-lung transplants by means of partial and maximal forced expiratory manoeuvres. Four showed bronchodilation after a deep breath, indicating that this response can occur after extrinsic pulmonary denervation in man. The patients with heart-lung transplants described a "tight" sensation in the anterior chest during bronchoconstriction, indicating that this sensation is not dependent on pulmonary innervation.
心肺联合移植手术会导致心脏、肺以及气管水平以下气道的急性去神经支配。将12例心肺移植受者对吸入乙酰甲胆碱的支气管收缩反应，与12例接受类似药物治疗的心脏移植受者以及12名正常受试者的反应进行了比较。心肺移植受者使第一秒用力呼气量（FEV1）至少降低20%的乙酰甲胆碱中位剂量（PC20）为8毫克/毫升，显著低于心脏移植受者（64毫克/毫升）和正常受试者（大于64毫克/毫升）。气道反应性增加可能与慢性肺去神经支配或气道亚临床炎症的影响有关。通过部分和最大用力呼气动作，对6例心肺移植患者去神经支配对支气管收缩期间对完全吸气反应的影响进行了研究。4例患者深呼吸后出现支气管扩张，表明人类在肺外去神经支配后可能会出现这种反应。心肺移植患者描述在支气管收缩期间前胸有“紧绷”感，表明这种感觉不依赖于肺神经支配。
