Barnas G M, Delaney P A, Gheorghiu I, Mandava S, Russell R G, Kahn R, Mackenzie C F
Department of Anesthesiology, University of Maryland, Baltimore, Maryland 21201, USA.
J Appl Physiol (1985). 1997 Jul;83(1):179-88. doi: 10.1152/jappl.1997.83.1.179.
We examined how the changes in the acini caused by emphysema affected gas transfer out of the acinus (Taci) and lung and chest wall mechanical properties. Measurements were taken from five dogs before and 3 mo after induction of severe bilateral emphysema by exposure to papain aerosol (170-350 mg/dose) for 4 consecutive wk. With the dogs anesthetized, paralyzed, and mechanically ventilated at 0.2 Hz and 20 ml/kg, we measured Taci by the rate of washout of 133Xe from an area of the lung with occluded blood flow. Measurements were repeated at positive end-expiratory pressures (PEEP) of 10, 5, 15, 0, and 20 cmH2O. We also measured dynamic elastances and resistances of the lungs (EL and RL, respectively) and chest wall at the different PEEP and during sinusoidal forcing in the normal range of breathing frequency and tidal volume. After final measurements, tissue sections from five randomly selected areas of the lung each showed indications of emphysema. Taci during emphysema was similar to that in control dogs. EL decreased by approximately 50% during emphysema (P < 0.05) but did not change its dependence on frequency or tidal volume. RL did not change (P > 0.05) at the lowest frequency studied (0.2 Hz), but in some dogs it increased compared with control at the higher frequencies. Chest wall properties were not changed by emphysema (P > 0.05). We suggest that although large changes in acinar structure and EL occur during uncomplicated bilateral emphysema, secondary complications must be present to cause several of the characteristic dysfunctions seen in patients with emphysema.
我们研究了肺气肿引起的腺泡变化如何影响气体从腺泡排出(Taci)以及肺和胸壁的力学特性。对5只狗进行了测量,在连续4周暴露于木瓜蛋白酶气雾剂(170 - 350毫克/剂量)诱导严重双侧肺气肿之前和之后3个月进行测量。在狗麻醉、麻痹并以0.2赫兹和20毫升/千克进行机械通气的情况下,我们通过从肺的一个血流被阻断区域冲洗出133Xe的速率来测量Taci。在呼气末正压(PEEP)为10、5、15、0和20厘米水柱时重复测量。我们还测量了在不同PEEP下以及在正常呼吸频率和潮气量范围内进行正弦波刺激时肺(分别为EL和RL)和胸壁的动态弹性和阻力。在最终测量后,从肺的五个随机选择区域获取的组织切片均显示出肺气肿的迹象。肺气肿期间的Taci与对照狗相似。肺气肿期间EL下降约50%(P < 0.05),但其对频率或潮气量的依赖性未改变。在研究的最低频率(0.2赫兹)下RL未改变(P > 0.05),但在一些狗中,与对照相比,在较高频率下RL增加。肺气肿未改变胸壁特性(P > 0.05)。我们认为,尽管在单纯性双侧肺气肿期间腺泡结构和EL发生了很大变化,但必须存在继发性并发症才能导致肺气肿患者出现一些典型的功能障碍。