Ventilation asymmetry after transplantation for emphysema - Role of chest wall and mediastinum
Ventilation asymmetry after transplantation for emphysema - Role of chest wall and mediastinum
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DOI：
10.1164/rccm.200403-323oc
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发表时间：
2004-12-01
影响因子：
24.7
通讯作者：
Estenne, M
中科院分区：
文献类型：
--
作者：
De Groote, A;Van Muylem, A;Estenne, M
肺气肿单肺移植后，过度充气的自体肺和移植物具有不同的充气和排空程度和速度。这要求呼吸产生胸壁的不对称扩张、纵隔的移位或两者兼而有之。在对四名坐着的移植受者的第一项研究中，我们用光电体积描记法测量了两个半胸的体积。原生侧和移植侧的功能残气量和总肺容量相同，并且两侧在 CO2 诱导的呼吸过度和 FVC 操作期间胸壁体积的变化相似。对其中三名患者和另外四名仰卧位患者的计算机断层扫描研究表明，纵隔在功能残气量和总肺容量方面向移植物移动。在潮气和完全吸气期间，纵隔向自体肺移动；在潮气和用力呼气期间，纵隔向移植肺移动；其他荧光透视研究显示直立姿势有类似的变化。总之，在单肺移植治疗肺气肿的患者中，两个半胸假定相同的静态体积，并且在 CO2 诱导的呼吸过度和 FVC 操作期间显示出相似的体积变化。纵隔的移位可容纳部分（如果不是全部）不等的肺容量和不对称的通气。
After single-lung transplantation for emphysema, the hyperinflated native lung and the graft have different extents and rates of inflation and emptying. This requires that breathing produces asymmetrical expansion of the chest wall, displacement of the mediastinum, or both. In a first study in four seated transplant recipients, we measured the volumes of the two hemithoraces with optoelectronic plethysmography. Functional residual capacity and total lung capacity were identical on the native and transplanted sides, and changes in chest wall volume during CO2-induced hyperpnea and FVC maneuvers were similar on both sides. Studies with computerized tomography in three of these patients and in four additional patients in supine posture indicated that the mediastinum was shifted toward the graft at functional residual capacity and total lung capacity. The mediastinum moved toward the native lung during tidal and full inspiration and toward the graft during tidal and forced expiration; additional studies with fluoroscopy showed qualitatively similar changes in upright posture. In summary, the two hemithoraces assume identical static volumes and show similar volume changes during CO2-induced hyperpnea and FVC maneuvers in patients with single-lung transplantation for emphysema; displacement of the mediastinum accommodates part, if not all, of the unequal lung volumes and asymmetrical ventilation.