Respiratory Mechanics in Lung Disease and Surgery

肺部疾病和外科手术中的呼吸力学

• 批准号: 6537132
• 负责人: STEPHEN H LORING
• 金额: $ 27.79万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-01 至 2005-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6537132
• 关键词: biomechanics; chronic obstructive pulmonary disease; computed axial tomography; homologous transplantation; human subject; human therapy evaluation; lung; lung transplantation; muscle function; patient oriented research; plethysmography; postoperative state; preoperative state; pulmonary respiration; respiratory airway volume; respiratory function; respiratory muscles; respiratory surgery; thorax

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is a life-threatening, debilitating disease affecting more than 2 million Americans. New surgical therapies such as lung transplantation and lung volume reduction surgery (LVRS) can improve quality of life and pulmonary function in COPD. However, questions remain as to which patients are most likely to benefit from these therapies and why surgery is effective in some patients and not in others. We will continue an observational study of respiratory mechanics in a large cohort of patients with COPD before and after lung transplantation and LVRS. Our rationale is that our coordinated program of respiratory mechanical investigation will continue to provide insights and suggest useful measures of respiratory function that will reveal mechanisms of disease. Specific aims are: 1) To measure the maximal inspiratory pressure-volume characteristic of the chest wall in patients before and after lung transplantation or LVRS to assess changes in inspiratory function of the chest wall. We will test the hypothesis that inspiratory function of the chest wall is often compromised after operation, and that chest wall restriction is an important cause of failure to improve after LVRS or single lung transplantation for emphysema. If true, this finding would lead to studies of the origins and remedies of chest wall restriction after surgery. 2) To explore the differences between lung volumes measured by multiple breath helium dilution, plethysmography, and computed tomography (CT). Accurate measurements of lung volume are essential for diagnosis, for documentation of hyperinflation, for evaluation of patients before surgery, and for assessment of the effects of LVRS and transplantation. We will test the hypothesis that, contrary to current belief, helium dilution is more accurate than plethysmography in patients with COPD. If true, this finding would change clinical practice in this important group. 3) To develop methods to measure the pressure-area characteristics of the trachea in patients undergoing bronchoscopy and to determine whether the site of expiratory flow limitation in these patients is in the lungs or trachea. Acquired tracheomalacia is reportedly common in patients with COPD, and can cause severe expiratory obstruction that may be relieved by stenting or surgical reinforcement of the airway. We will test the hypothesis that many patients with demonstrated tracheomalacia and central airway collapse have obstruction caused by collapse of intrapulmonary airways, which is not amenable to surgical correction. Our findings will provide normative data on tracheal collapsibility not currently available, explore the association between tracheomalacia and COPD, and test a method for predicting the effect of stenting on expiratory obstruction in these patients.

描述（由申请人提供）：慢性阻塞性肺疾病 慢性阻塞性肺疾病（COPD）是一种危及生命、使人衰弱的疾病， 百万美国人。新的外科治疗，如肺移植和肺 减容手术（LVRS）可以改善患者的生活质量和肺功能， 在COPD中的作用然而，问题仍然存在，哪些患者最 可能从这些治疗中受益，以及为什么手术在一些 病人，而不是其他人。我们将继续进行观察性研究， 一个大型队列COPD患者治疗前后的呼吸力学 肺移植和LVRS。我们的理由是，我们的协调计划， 呼吸机械研究将继续提供见解， 提出了有用的呼吸功能测量方法，将揭示 疾病具体目的是：1）测量最大吸气量 胸壁压力-容积特性 肺移植或LVRS，以评估患者吸气功能的变化。 胸壁侧我们将检验胸腔的吸气功能 手术后胸壁经常受到损害，胸壁限制是 LVRS或单肺切除术后未能改善的重要原因 移植治疗肺气肿如果这是真的，这一发现将导致对 术后胸壁受限的原因及治疗。2)探讨 多次呼吸氦气测量的肺容量之间的差异 稀释、体积描记和计算机断层扫描（CT）。精确的测量 肺容量的变化对于诊断、记录 过度充气，用于术前患者评价和评估 LVRS和移植的效果。我们将检验这个假设， 与目前的看法相反，氦稀释比 COPD患者的体积描记法。如果这是真的， 在这个重要的群体中的临床实践。3)制定方法来衡量 气管插管患者的气管压力-面积特征 支气管镜检查，并确定是否呼气流量限制的网站， 这些病人是在肺部或气管。获得性气管软化症是 据报道，COPD患者中常见， 可以通过支架植入术或手术加固 气道。我们将检验一个假设，即许多患有 气管软化和中央气道塌陷有塌陷引起的阻塞 肺内气道，这是不适合手术纠正。我们 研究结果将提供目前尚未提供的关于气管可扩张性的规范性数据 现有资料，探索气管软化症和COPD之间的关系，并测试a 用于预测支架植入术对这些患者呼气阻塞的影响的方法 患者