Weitzenblum E, Hirth C, Parini J P, Roeslin N, Ravault M C, Oudet P
Respiration. 1976;33(3):188-98. doi: 10.1159/000193733.
The comparative ventilatory responsiveness to CO2 was studied in 13 chronic bronchitics and 14 emphysematous patients, all exhibiting respiratory insufficiency and with FEV1 less than 1,500 ml. The gas inhaled was enriched with oxygen (F1O2 =0.6) and contained 6% CO2, and measurements were taken when the patients had reached a stable state. The ratio delta VE/deltaPaCO2, which represents the ventilatory responsiveness to CO2, was higher in the emphysematous patients (1.18+/-0.51 liters-min-1. Torr-1) than in the bronchitics (0.76+/-0.34, p less than 0.025), but the deviation on either side of the mean was large in each group. The ventilatory responsiveness to CO2 was proportional to the initial PaCO2, FEV1, total airways resistance, total pulmonary work and especially to inspiratory mechanical work done on the lung ( r=-0.73, p less than 0.001). The difference in ventilatory responsiveness to CO2 between the bronchitic and emphysematous patients may be explained by the difference in energy expended in breathing. It was not possible to exclude an effect due to a difference in sensitivity within the respiratory centers, since inspiratory mechanical work was not measured during CO2 inhalation. It was thought likely that mechanical factors play a triggering role, in that they cause a fall in ventilatory responsiveness to CO2 and hypercapnia, the latter causing the central hyposensitivity which maintains the retention of CO2.
对13例慢性支气管炎患者和14例肺气肿患者的二氧化碳通气反应性进行了比较研究，所有患者均表现出呼吸功能不全，且第一秒用力呼气容积（FEV1）小于1500毫升。吸入气体富含氧气（吸入氧分数=F1O2 =0.6）并含有6%的二氧化碳，在患者达到稳定状态时进行测量。代表对二氧化碳通气反应性的δVE/δPaCO2比值在肺气肿患者中（1.18±0.51升·分钟-1·托-1）高于慢性支气管炎患者（0.76±0.34，p<0.025），但每组中均值两侧的偏差都很大。对二氧化碳的通气反应性与初始动脉血二氧化碳分压（PaCO2）、FEV1、气道总阻力、总肺功，尤其是对肺所做的吸气机械功成正比（r=-0.73，p<0.001）。慢性支气管炎患者和肺气肿患者对二氧化碳通气反应性的差异可能由呼吸时消耗的能量差异来解释。由于在吸入二氧化碳期间未测量吸气机械功，因此无法排除呼吸中枢敏感性差异所产生的影响。认为机械因素可能起触发作用，因为它们导致对二氧化碳的通气反应性下降和高碳酸血症，后者导致中枢性低敏感性，从而维持二氧化碳潴留。
