Mohsenifar Z, Jasper A C, Koerner S K
Division of Pulmonary Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine 90048-1869.
Chest. 1988 Jan;93(1):65-9. doi: 10.1378/chest.93.1.65.
We performed YAG laser photoresection in 11 patients with tracheal or mainstem bronchial obstruction due to malignant or benign disorders. We used maximal inspiratory-expiratory flow-volume loops and expiratory volume-time plots to assess air flow limitation. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and iso-volume maximal flows at 50 percent of forced inspiratory and expiratory volume were calculated. Spirograms and flow-volume loops were repeated within 12 to 72 hours of laser resection. All patients had flattened expiratory limbs on their flow-volume loops. All spirometric parameters increased significantly following laser photoresection. In particular, peak flow improved in all patients, and FEV1 improved in nine of 11 patients, even though four patients had moderate to severe obstructive ventilatory defects which persisted after resection and were probably due to longstanding chronic obstructive pulmonary disease. We conclude that flow-volume loops and spirometry are helpful in assessing the site and nature of malignant large airway obstructive processes and, moreover, provide reliable information for evaluating the efficacy of laser photoresection. Serial physiologic studies indicate changes in the caliber of the upper airways and can be used as a simple means of following these patients.
我们对11例因恶性或良性疾病导致气管或主支气管阻塞的患者进行了YAG激光光切除术。我们使用最大吸气-呼气流量容积环和呼气容积-时间图来评估气流受限情况。计算了用力肺活量（FVC）、一秒用力呼气容积（FEV1）、呼气峰值流量（PEF）以及在用力吸气和呼气容积50%时的等容积最大流量。在激光切除术后12至72小时内重复进行肺量计检查和流量容积环检查。所有患者的流量容积环呼气支均变平。激光光切除术后所有肺量计参数均显著增加。特别是，所有患者的峰值流量均有所改善，11例患者中有9例的FEV1有所改善，尽管有4例患者存在中度至重度阻塞性通气缺陷，这些缺陷在切除术后仍然存在，可能是由于长期慢性阻塞性肺疾病所致。我们得出结论，流量容积环和肺量计有助于评估恶性大气道阻塞性病变的部位和性质，此外，还可为评估激光光切除术的疗效提供可靠信息。系列生理学研究表明上气道管径发生了变化，可作为跟踪这些患者的一种简单方法。
