ABNORMAL PULMONARY-FUNCTION SPECIFICALLY RELATED TO CONGESTIVE HEART-FAILURE - COMPARISON OF PATIENTS BEFORE AND AFTER CARDIAC TRANSPLANTATION
ABNORMAL PULMONARY-FUNCTION SPECIFICALLY RELATED TO CONGESTIVE HEART-FAILURE - COMPARISON OF PATIENTS BEFORE AND AFTER CARDIAC TRANSPLANTATION
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DOI：
10.1016/0002-9343(90)90428-g
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发表时间：
1990-05-01
影响因子：
5.9
通讯作者：
SHELLEY, D
中科院分区：
文献类型：
--
作者：
HOSENPUD, JD;STIBOLT, TA;SHELLEY, D
目的：多种肺功能异常可归因于或据信因充血性心力衰竭而加剧。区分心脏疾病和肺部疾病的具体贡献是很困难的。为了研究心脏病对肺功能的影响，我们在心脏移植前后立即对患者进行了肺量测定。患者和方法：之前研究了 17 名患者（13 名男性，4 名女性），平均年龄为 44 岁（范围：20 至 62 岁），15 名患者接受了研究。心脏移植后 10（平均±SD）个月。 11名患者有明显的吸烟史。结果：比较移植前和移植后的肺量测定结果，移植后用力肺活量 (FVC) 和 1 秒用力呼气量 (FEV1) 显着增加（3.34 .+-. 0.96 L 与 3.89 .+-. 1.00 L，p = 0.0054，以及 2.63 .+-. 0.80 L 与 2.95 .+-. 0.83 L，p = 0.042，分别）。整个组的研究状态之间的 FEV1/FVC 没有显着差异（0.78 .+-. 0.10 与 0.76 .+-. 0.10，p = NS），有或无吸烟史的患者也没有差异（0.76 .+-. 0.11 与 0.72 .+-. 0.10，p = NS，和 0.87 .+-. 0.10，p = NS）。 0.06 与 0.84 .+- 0.02，p = NS，分别）。此外，与有吸烟史的患者相比，无吸烟史的患者在移植后获得了正常的肺容量。最后，心脏移植后 FVC 的增加与心脏置换后心脏体积的减少直接相关（r = 0.83，p < 0.0001）。结论：我们的结论是，在被选为心脏移植候选人的患者（没有严重阻塞性肺病的患者）中，限制性而非阻塞性肺生理学可部分归因于充血性心力衰竭，而肺容量减少的主要部分是继发于大心脏所占据的空间。其他因素，例如伴随的胸腔积液和间质水肿，可能导致肺容量减少。在该选定人群中，继发于慢性充血性心力衰竭的肺功能异常随着心血管生理学和解剖学的正常化而完全可逆。
PURPOSE: A variety of abnormalities in pulmonary function have been attributed to, or are believed to be, exacerbated by congestive heart failure. Separating out specific contributions from cardiac versus pulmonary disease is difficult. In order to investigate the impact of cardiac disease on pulmonary function, we performed spirometry on patients immediately before and after cardiac transplantation. PATIENTS AND METHODS: Seventeen patients (13 men, 4 women) with a mean age of 44 years (range: 20 to 62 years) were studied before and 15 .+-. 10 (mean .+-. SD) months after cardiac transplantation. Eleven patients had a significant smoking history. RESULTS: In comparing pre- and post-transplant spirometric results, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) increased substantially after transplant (3.34 .+-. 0.96 L versus 3.89 .+-. 1.00 L, p = 0.0054, and 2.63 .+-. 0.80 L versus 2.95 .+-. 0.83 L, p = 0.042, respectively). FEV1/FVC was not significantly different between study states in the entire group (0.78 .+-. 0.10 versus 0.76 .+-. 0.10, p = NS), nor was it different in those patients with and without a smoking history (0.76 .+-. 0.11 versus 0.72 .+-. 0.10, p = NS, and 0.87 .+-. 0.06 versus 0.84 .+-. 0.02, p = NS, respectively). Furthermore, normal lung volumes were obtained after transplant in those patients without a smoking history in contrast to those with a smoking history. Finally, the increase in FVC after cardiac transplantation directly correlated with the decrease in cardiac volume with cardiac replacement (r = 0.83, p < 0.0001). CONCLUSION: We conclude that in patients selected as cardiac transplant candidates (those without severe obstructive lung disease), restrictive but not obstructive pulmonary physiology can be attributed in part to congestive heart failure, and a major part of the reduction in lung volumes is secondary to the space occupied by a large heart. Other factors such as accompanying pleural effusions and interstitial edema, likely contribute to the reduction in lung volumes. Abnormal pulmonary function secondary to chronic congestive heart failure in this selected population is completely reversible with normalization of cardiovascular physiology and anatomy.