Dynamic lung mechanics in late-stage emphysema before and after lung volume reduction surgery

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• 作者：A. Cortney Henderson ; Edward P. Ingenito ; Edgardo S. Salcedo ; Marilyn L. Moy ; John J. Reilly ; Kenneth R. Lutchen
• 关键词：Chronic obstructive pulmonary disease ; Inspiratory lung impedance ; Inspiratory lung resistance ; Inspiratory lung elastance ; Heterogeneity
• 刊名：Respiratory Physiology & Neurobiology
• 出版年：2007
• 期刊代码：185_15699048
• 类别：bio
• 出版时间：15 March 2007
• 卷：155
• 期：3
• 页码：234-242
• 文件大小：703 K

摘要

This study evaluated the effects of lung volume reduction surgery (LVRS) on the heterogeneity of lung function in awake, late-stage emphysema patients with measurements taken before and after full recovery from LVRS. We assessed standard clinical measures of lung function and functional heterogeneity in six awake, late-stage emphysema patients before and 6 months after LVRS. Functional heterogeneity was quantified by measuring dynamic inspiratory resistance and elastance over a frequency range that included normal breathing (0.33–8 Hz). Since LVRS involves targeted resection of emphysematous regions of the lung, we hypothesized that emphysema patients would be functionally more homogeneous post-LVRS. We also compared our measures of functional heterogeneity with indices of anatomic heterogeneity and severity using high-resolution computed tomography (HRCT). After LVRS, 6 min walk distance increased by 22%(940 ± 91 versus 1158 ± 299, p = 0.031) and recoil pressure at TLC increased (9.0 ± 2.0 versus 14 ± 5, p = 0.031), but changes in and varied greatly between subjects. A measure of anatomic severity quantified using HRCT positively correlated with airway resistance (r_s = 0.89, p = 0.048). These results suggest that subjects with more severe disease as assessed by HRCT criteria had reduced overall effective airway caliber consequent to active airway constriction, reduced parenchymal tethering, and/or loss of parallel lung units. Furthermore, LVRS may not necessarily improve lung function via a substantial reduction in mechanical heterogeneity.