Kaminsky D A, Wenzel S E, Carcano C, Gurka D, Feldsien D, Irvin C G
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, USA.
Am J Respir Crit Care Med. 1997 Apr;155(4):1260-6. doi: 10.1164/ajrccm.155.4.9105064.
The effects of hyperpnea on parenchymal lung mechanics are unknown, but they may contribute to the resultant airflow limitation commonly seen in asthma. To investigate these effects, we measured the following parameters in seven asthmatic and six normal subjects before and after 5 min of hyperpnea: specific conductance, upstream resistance, static compliance, the coefficient of retraction, lung volumes, lung hysteresis, and the ratio of maximal to partial flow rates (the M:P ratio, an indicator of the effect of deep inhalation on airflow, and a measure of relative airway and parenchymal hysteresis). In addition to a central effect on the airways, as shown by significant falls in specific conductance, hyperpnea in asthmatics, but not in normal subjects, resulted in significant increases in residual volume and pressure-volume hysteresis, suggestive of changes in parenchymal lung mechanics. The M:P ratio also increased in the asthmatics, consistent with greater increases in airway than in parenchymal hysteresis after hyperpnea. We conclude that hyperpnea has significant effects on the lung parenchyma that contribute to airflow limitation in asthmatics, and we hypothesize that these effects may be due to alterations in peripheral airway smooth muscle tone and surfactant function.
深呼吸对肺实质力学的影响尚不清楚,但它们可能是哮喘中常见的气流受限的原因之一。为了研究这些影响,我们在7名哮喘患者和6名正常受试者进行5分钟深呼吸前后测量了以下参数:比传导率、上游阻力、静态顺应性、回缩系数、肺容积、肺滞后现象以及最大流速与部分流速之比(M:P比值,是深吸气对气流影响的指标,也是相对气道和肺实质滞后现象的度量)。除了对气道有中枢性影响(表现为比传导率显著下降)外,哮喘患者而非正常受试者的深呼吸还导致残气量和压力-容积滞后现象显著增加,提示肺实质力学发生了变化。哮喘患者的M:P比值也增加了,这与深呼吸后气道滞后现象的增加幅度大于肺实质滞后现象一致。我们得出结论,深呼吸对肺实质有显著影响,这是哮喘患者气流受限的原因之一,并且我们推测这些影响可能是由于外周气道平滑肌张力和表面活性物质功能的改变所致。