Marthan R, Castaing Y, Manier G, Guenard H
Chest. 1985 Apr;87(4):470-5. doi: 10.1378/chest.87.4.470.
In a series of 23 patients with COPD, Wagner et al showed three distinct patterns of VA/Q distributions and a correlation between Burrows' clinical classification and the observed distribution patterns. Using the inert gas method, we studied 51 patients suffering from severe but stable COPD (FEV1 = 0.84 +/- 0.38 L; PaO2 = 58.5 +/- 10.5 mm Hg; PaCo2 = 48 +/- 6 mmHg; Ppa = 22 +/- 8 mmHg) breathing room air in a steady state. The H pattern (high mode of VA in high VA/Q) was found in 24 cases. There was an L pattern (Q mode in low VA/Q units) in nine cases and an HL (high-low) pattern in 16 cases (two patients were assigned another group). The analysis of the distribution data confirmed that VA/Q heterogeneity was the main factor underlying gas exchange disturbances in COPD. The PaO2 of the H subjects was higher than that of both HL (p less than 0.02) and L subjects. The true shunt value in the L group was significantly lower than in the H and HL groups. However, the relationship between clinical or functional aspects and distribution was not direct. The fraction of patients of H, HL, or (H + HL) types was nearly identical in the three clinical groups. The H pattern was found to be predominant in cases of COPD.
在一组23例慢性阻塞性肺疾病（COPD）患者中，瓦格纳等人展示了三种不同的通气/血流比值（VA/Q）分布模式，以及伯罗斯临床分类与观察到的分布模式之间的相关性。我们采用惰性气体法，研究了51例患有严重但稳定的COPD患者（第一秒用力呼气容积[FEV1]=0.84±0.38升；动脉血氧分压[PaO2]=58.5±10.5毫米汞柱；动脉血二氧化碳分压[PaCo2]=48±6毫米汞柱；肺动脉压[Ppa]=22±8毫米汞柱），这些患者在静息状态下呼吸室内空气。发现24例呈现H模式（高VA/Q时的高VA模式）。9例呈现L模式（低VA/Q单位时的Q模式），16例呈现HL（高低）模式（两名患者被归为另一组）。对分布数据的分析证实，VA/Q不均一性是COPD气体交换障碍的主要因素。H组患者的PaO2高于HL组（p<0.02）和L组。L组的真正分流值显著低于H组和HL组。然而，临床或功能方面与分布之间的关系并不直接。在三个临床组中，H型、HL型或（H+HL）型患者的比例几乎相同。在COPD病例中，H模式被发现占主导地位。
