Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery.
Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery.
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改变胸部气体压缩有助于改善肺减容手术的肺活量测定。
DOI：
10.1136/thx.2004.033589
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
Boriek,AM
中科院分区：
文献类型：
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作者：
Sharafkhaneh,A;Goodnight-White,S;Officer,TM;Rodarte,JR;Boriek,AM
背景：胸部气体压缩（TGC）对用力呼气流量产生负面影响。肺阻力、用力呼气动作期间的用力以及绝对肺容量都会影响 TGC。肺减容手术（LVRS）可降低肺阻力和绝对肺容量。因此，LVRS 可能会减少 TGC，这种减少可能部分解释了手术后用力呼气流量的改善。进行了一项研究以确定 LVRS 对 TGC 的影响，以及减少 TGC 在多大程度上有助于 LVRS 后 1 秒用力呼气量 (FEV1) 的改善。方法：使用前瞻性收集的 27 名严重肺气肿受试者的肺力学数据来研究 LVRS 对 TGC 的影响。在基线和术后 6 个月测量了几个参数，包括 FEV1、呼气和吸气肺阻力（Rle 和 Rli）以及肺容量。使用跨肺压测量强制机动期间的作用力。使用一种新方法来估计根据 TGC 的影响校正的 FEV1。结果：在基线时，根据气体压缩校正的 FEV1 (NFEV1) 显着高于 FEV1 (p<0.0001)。 FEV1 较基线显着增加 (p<0.005)，而 NFEV1 术后没有变化 (p>0.15)。 LVRS 后 TGC 显着降低 (p<0.05)。强制机动期间的 Rle 和最大跨肺压 (TPpeak) 显着预测手术后 TGC 的降低（Rle：p<0.01；TPpeak：p<0.0001；调整后的 R2= 0.68）。 FEV1 的改善与术后 TGC 的减少相关（p<0.0001，调整后的 R2= 0.58）。结论：LVRS 通过改善呼气流量限制来减少 TGC。反过来，TGC 的减少减少了其对呼气流量的负面影响，因此部分解释了该队列中 LVRS 导致 FEV1 的改善。
Background:Thoracic gas compression (TGC) exerts a negative effect on forced expiratory flow. Lung resistance, effort during a forced expiratory manoeuvre, and absolute lung volume influence TGC. Lung volume reduction surgery (LVRS) reduces lung resistance and absolute lung volume. LVRS may therefore reduce TGC, and such a reduction might explain in part the improvement in forced expiratory flow with the surgery. A study was conducted to determine the effect of LVRS on TGC and the extent to which reduced TGC contributed to an improvement in forced expiratory volume in 1 second (FEV1) following LVRS.Methods:The effect of LVRS on TGC was studied using prospectively collected lung mechanics data from 27 subjects with severe emphysema. Several parameters including FEV1, expiratory and inspiratory lung resistance (Rle and Rli), and lung volumes were measured at baseline and 6 months after surgery. Effort during the forced manoeuvre was measured using transpulmonary pressure. A novel method was used to estimate FEV1corrected for the effect of TGC.Results:At baseline the FEV1corrected for gas compression (NFEV1) was significantly higher than FEV1(p<0.0001). FEV1increased significantly from baseline (p<0.005) while NFEV1did not change following surgery (p>0.15). TGC decreased significantly with LVRS (p<0.05). Rle and maximum transpulmonary pressure (TPpeak) during the forced manoeuvre significantly predicted the reduction in TGC following the surgery (Rle: p<0.01; TPpeak: p<0.0001; adjustedR2= 0.68). The improvement in FEV1was associated with the reduction in TGC after surgery (p<0.0001, adjustedR2= 0.58).Conclusions:LVRS decreased TGC by improving expiratory flow limitation. In turn, the reduction in TGC decreased its negative effect on expiratory flow and therefore explained, in part, the improvement in FEV1with LVRS in this cohort.