Airway Bypass Improves the Mechanical Properties of Explanted Emphysematous Lungs
Airway Bypass Improves the Mechanical Properties of Explanted Emphysematous Lungs
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DOI：
10.1164/rccm.200712-1832oc
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发表时间：
2008-11-01
影响因子：
24.7
通讯作者：
Cooper, Joel D.
中科院分区：
文献类型：
--
作者：
Choong, Cliff K.;Macklem, Peter T.;Cooper, Joel D.
基本原理：通过建立人工通道穿过支气管壁进入受损肺实质（气道转流），我们期望减少气体的滞留量和增加在强制性呼吸期间排出的空气的速率和体积。目的：描述气道转流改善肺气肿肺的机械特性的机制。方法：在气道旁路术之前和之后测量肺室和力学，气道旁路术是通过在移植手术中取出的10个肺气肿肺中放置三个或四个支架支持的开窗来创建的。被动回缩后的最小容量平均减少1.54 L（范围：0.7-2.5 L）或60%（范围：37-86%）。取出的VC增加了1.30 L或132%（范围，78-318%）。最大呼气流量和容量增加。结论：由于这些数据表明，气道旁路改善了严重肺气肿肺在体外的呼吸力学，现在有强有力的经验支持，这一程序可以改善患者的呼吸功能，减少气体截留和流动阻力。
Rationale: By creating artificial communications through bronchial walls into the parenchyma of explanted lungs (airway bypass), we expect to decrease the amount of gas trapped and to increase the rate and volume of air expelled during forced expirations.Objectives: To describe the mechanism by which airway bypass improves the mechanical properties of the emphysematous lung.Methods: Lung compartments and mechanics were measured before and after airway bypass, which was created by placement of three or four stent-suppported fenestrations in 10 emphysematous lungs removed at transplantation surgery.Measurements and Main Results: Minimal volume after passive deflation decreased by a mean of 1.54 L (range, 0.7-2.5 L) or 60% (range, 37-86%). Explanted VC increased by 1.30 L or 132% (range, 78-318%). Maximal expiratory flows and volumes increased. Flow resistance decreased.Conclusions: Because these data show that airway bypass improves the mechanics of breathing in severely emphysematous lungs in vitro, there is now strong empirical support that this procedure can improve ventilatory function in patients by reducing gas trapping and flow resistance.