Hogg J C, Macklem P T, Thurlbeck W M
J Clin Invest. 1969 Mar;48(3):421-31. doi: 10.1172/JCI105999.
We measured the resistance of collateral channels, R(col), in incomplete interlobar fissures in eight normal and eight emphysematous excised human lungs. Similar measurements were also made from the basal segments to the superior segment of the lower lobe in three normal and five emphysematous lungs. The lobe or segments were inflated through a bronchial cannula; air leaked through collateral channels and out of the other lobe or segment through a pneumotachograph which measured flow. Catheters inserted directly into the lung through the pleural surface on either side of the collateral channels measured the alveolar pressure difference producing collateral flow. R(col) is the ratio of this pressure difference to flow. By also measuring the inflating pressure and the airway pressure at the pneumotachograph, we calculated the lobar or segmental airway resistance, R(aw). In the normal lungs R(col) varied inversely with lung volume and was higher on inflation than on deflation. R(aw) was very small compared to R(col) which ranged from 260 to 3300 cm H(2)O/liter per sec when the distending pressure was 20 cm H(2)O. In the emphysematous lungs on the other hand, R(col) was markedly decreased and ranged from 5 to 20 cm H(2)O/liters per sec at the same distending pressure and was less than R(aw). We conclude that collateral channels are important ventilatory pathways in emphysema. When many units within a lung are ventilated by these pathways there may be disturbances of gas exchange and phase differences between normally and abnormally ventilated areas.
我们测量了8个正常和8个肺气肿切除的人肺中不完全叶间裂旁侧通道的阻力R(col)。还对3个正常肺和5个肺气肿肺从下叶基底段到上叶进行了类似测量。通过支气管插管对肺叶或肺段进行充气;空气通过旁侧通道泄漏,并通过测量流量的呼吸流速计从另一个肺叶或肺段流出。直接通过旁侧通道两侧胸膜表面插入肺内的导管测量产生旁侧气流的肺泡压差。R(col)是该压差与流量的比值。通过同时测量充气压力和呼吸流速计处的气道压力,我们计算了肺叶或肺段气道阻力R(aw)。在正常肺中,R(col)与肺容积呈反比,充气时高于放气时。与R(col)相比,R(aw)非常小,当扩张压力为20 cm H₂O时,R(col)范围为260至3300 cm H₂O/升每秒。另一方面,在肺气肿肺中,R(col)明显降低,在相同扩张压力下范围为5至20 cm H₂O/升每秒,且小于R(aw)。我们得出结论,旁侧通道是肺气肿中重要的通气途径。当肺内许多单位通过这些途径通气时,可能会出现气体交换紊乱以及正常通气区域和异常通气区域之间的相位差异。