Dynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease.
Dynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease.
复制标题
慢性阻塞性肺疾病的动态过度通货膨胀和呼吸机依赖。
DOI：
10.1164/arrd.1982.126.6.991
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Robins,AG
中科院分区：
文献类型：
--
作者：
Kimball,WR;Leith,DE;Robins,AG
在晚期慢性阻塞性肺疾病中，功能残气量(FRC)可通过涉及呼气流速限制的动力学机制显著增加。我们研究了一名有这种变化的静坐呼吸机依赖患者的呼吸力学。放松呼气是限流的；可以在不降低呼气流速的情况下将9-27 cm H2O的压力(随肺容量而定)应用于气道开放(PAO)。FRC至少比松弛成交量高出2 L。吸气总阻力为16cmH2O/L/S，肺顺应性为0.16，胸壁为0.04，呼吸系统为0.032 L/cmH2O。更重要的是，吸气末和呼气末的反冲压分别为肺脏6.5和1.5 cm H2O，胸壁33和11 cm H2O，呼吸系统38和12 cm H2O。因此，胸壁始终向内回缩，胸膜压力始终为正值(11-33 cm H2O)，呼气流速最大，颈静脉始终充盈且无搏动。吸气功约为每次呼吸0.27公斤/米(是正常的7倍)，大部分是在胸壁上做的弹性功。
In advanced chronic obstructive pulmonary diseases, functional residual capacity (FRC) can be markedly increased by dynamic mechanisms involving expiratory flow limitation. We studied respiratory mechanics in a seated ventilator-dependent patient with such changes. Relaxed expiration was flow-limited; pressures of 9 to 27 cm H2O (varying with lung volume) could be applied to the airway opening (Pao) without decreasing expiratory flow rate. The FRC was at least 2 L above relaxation volume. Inspiratory total resistance was 16 cm H2O/L/s. Compliance of the lung was 0.16, chest wall was 0.04, and respiratory system was 0.032 L/cm H2O. More importantly, recoil pressures at end inspiration and end expiration, respectively, were 6.5 and 1.5 cm H2O for the lung, 33 and 11 cm H2O for chest wall, and 38 and 12 cm H2O for the respiratory system. Thus the chest wall recoiled inward at all times, pleural pressure was always substantially positive (11 to 33 cm H2O), expiratory flow was maximal, and jugular veins were always full and nonpulsating. Inspiratory work was about 0.27 kg-m per breath (7 times normal), most of it elastic work done on the chest wall.