Chang S C, Chang H I, Chen F J, Shiao G M, Wang S S
Chest Department, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Proc Natl Sci Counc Repub China B. 1995 Jul;19(3):143-50.
The effects of ascites and body position on gas exchange were evaluated in 22 male cirrhotics. All underwent spirometry and plethysmography in the sitting (erect) position. Single breath carbon monoxide diffusing capacity (DLco) was measured in the erect and supine positions in a random sequence. A significantly negative correlation was found between Kco (DLco corrected by alveolar volume [VA]) and lung volumes. DLco was significantly higher in the erect than in the supine position. On the other hand, Kco was significantly higher in the supine position. The differences of DLco and Kco between the erect and supine positions (the data in the supine minus those in the erect position) correlated highly with FEV1 and FVC. Thirteen patients underwent large volume paracentesis, and pulmonary function tests were done one day before and after paracentesis. Lung volumes and DLco increased significantly after paracentesis. In contrast, Kco decreased significantly. A significantly negative correlation was found between the change of Kco before and after paracentesis and that of lung volumes (the data after minus those before paracentesis). There was no remarkable change in the differences of DLco and Kco between the two positions after paracentesis. It is concluded that ascites may prevent further worsening of gas exchange and attenuate the postural effect on gas exchange in cirrhotic patients with significant amounts of ascites.
在22名男性肝硬化患者中评估了腹水和体位对气体交换的影响。所有人均在坐位（直立位）进行了肺活量测定和体积描记法检查。以随机顺序在直立位和仰卧位测量单次呼吸一氧化碳弥散量（DLco）。发现一氧化碳弥散系数（Kco，通过肺泡容积[VA]校正的DLco）与肺容积之间存在显著负相关。直立位时的DLco显著高于仰卧位。另一方面，仰卧位时的Kco显著更高。直立位和仰卧位之间DLco和Kco的差异（仰卧位数据减去直立位数据）与第一秒用力呼气容积（FEV1）和用力肺活量（FVC）高度相关。13名患者接受了大量腹腔穿刺放液术，在穿刺术前一天和术后进行了肺功能测试。腹腔穿刺放液术后肺容积和DLco显著增加。相比之下，Kco显著降低。腹腔穿刺放液术前和术后Kco的变化与肺容积的变化（术后数据减去术前数据）之间存在显著负相关。腹腔穿刺放液术后两个体位之间DLco和Kco的差异没有明显变化。结论是，腹水可能会阻止气体交换的进一步恶化，并减轻大量腹水的肝硬化患者体位对气体交换的影响。
