Kelsen S G, Prestel T F, Cherniack N S, Chester E H, Deal E C
J Clin Invest. 1981 Jun;67(6):1761-8. doi: 10.1172/jci110215.
The effects of resistive loads applied at the mouth were compared to the effects of bronchospasm on ventilation, respiratory muscle force (occlusion pressure), and respiratory sensations in 6 normal and 11 asthmatic subjects breathing 100% O2. External resistive loads ranging from 0.65 to 13.33 cm H2O/liter per s were applied during both inspiration and expiration. Bronchospasm was induced by inhalation of aerosolized methacholine. Bronchospasm increased ventilation, inspiratory airflow, respiratory rate, and lowered PACO2. External resistive loading, on the other hand, reduced respiratory rate and inspiratory flow, but left ventilation and PACO2 unaltered. FRC increased to a greater extent with bronchospasm than external flow resistive loads. With both bronchospasm and external loading, occlusion pressure increased in proportion to the rise in resistance to airflow. However, the change in occlusion pressure produced by a given change in resistance and the absolute level of occlusion pressure at comparable levels of airway resistance were greater during bronchospasm than during external loading. These differences in occlusion pressure responses to the two forms of obstruction were not explained by differences in chemical drive or respiratory muscle mechanical advantage. Although the subjects' perception of the effort involved in breathing was heightened during both forms of obstruction to airflow, at any given level of resistance the sense of effort was greater with bronchospasm than external loading. Inputs from mechanoreceptors in the lungs (e.g., irritant receptors) and/or greater stimulation of chest wall mechanoreceptors as a result of increases in lung elastance may explain the differing responses elicited by the two forms of resistive loading.
在6名正常受试者和11名哮喘受试者吸入100%氧气的情况下,比较了口腔施加的阻力负荷与支气管痉挛对通气、呼吸肌力量(阻断压)和呼吸感觉的影响。在吸气和呼气过程中均施加了范围为0.65至13.33厘米水柱/升每秒的外部阻力负荷。通过吸入雾化的乙酰甲胆碱诱发支气管痉挛。支气管痉挛增加了通气、吸气气流、呼吸频率,并降低了动脉血二氧化碳分压(PACO2)。另一方面,外部阻力负荷降低了呼吸频率和吸气流量,但通气和PACO2未改变。与外部气流阻力负荷相比,支气管痉挛使功能残气量(FRC)增加的程度更大。在支气管痉挛和外部负荷情况下,阻断压均与气流阻力的增加成比例增加。然而,在可比的气道阻力水平下,给定阻力变化所产生的阻断压变化以及阻断压的绝对水平在支气管痉挛时比外部负荷时更大。两种形式的阻塞在阻断压反应上的这些差异不能用化学驱动或呼吸肌机械优势的差异来解释。尽管在两种形式的气流阻塞过程中受试者对呼吸用力的感知都增强了,但在任何给定的阻力水平下,支气管痉挛时的用力感觉都比外部负荷时更大。来自肺部机械感受器(如刺激感受器)的输入和/或由于肺弹性增加导致胸壁机械感受器受到更大刺激,可能解释了两种形式的阻力负荷所引发的不同反应。