Effect of surgical lung volume reduction on breathing patterns in severe pulmonary emphysema

被引:59
作者
Bloch, KE [1 ]
Li, YM [1 ]
Zhang, JN [1 ]
Bingisser, R [1 ]
Kaplan, V [1 ]
Weder, W [1 ]
Russi, EW [1 ]
机构
[1] UNIV ZURICH HOSP, DEPT SURG, CH-8091 ZURICH, SWITZERLAND
关键词
D O I
10.1164/ajrccm.156.2.9608031
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Surgical lung volume reduction may improve pulmonary function and dyspnea in advanced pulmonary emphysema. To investigate mechanisms of these beneficial effects we studied breathing patterns before and after surgery. Nineteen patients with diffuse pulmonary emphysema (FEV1 < 35% of predicted, total lung capacity > 130% predicted) were studied within 1 mo before, and 1.5 to 7 mo after thoracoscopic volume reduction. Changes of rib cage and abdominal volumes were monitored with calibrated respiratory inductive plethysmography for 20 to 60 min during natural breathing at rest. Pulmonary function and dyspnea were also assessed. Postoperative tidal volumes, respiratory cycle times, and minute ventilation were not significantly different from preoperative values. The contribution of abdominal volume changes to tidal volumes increased from a mean +/- SD of 43 +/- 17% preoperatively to 58 +/- 14% postoperatively (p = 0.03). The fraction of inspiratory time with abdominal paradoxical motion decreased from 12.3 +/- 8.3% preoperatively to 5.1 +/- 5.1% postoperatively (p = 0.02). The phase shift between rib cage and abdominal motion was reduced postoperatively. Hyperinflation, airway obstruction, and subjective ratings of dyspnea were significantly improved. The better synchronization of rib cage-abdominal motion and the greater contribution of abdominal volume changes to tidal volumes are consistent with a reduction of inspiratory loading and a greater force-generating capacity of the diaphragm after surgery.
引用
收藏
页码:553 / 560
页数:8
相关论文
共 35 条
  • [1] DEFORMATION OF CHEST WALL DURING BREATHING EFFORTS
    AGOSTONI, E
    MOGNONI, P
    [J]. JOURNAL OF APPLIED PHYSIOLOGY, 1966, 21 (06) : 1827 - &
  • [2] INSPIRATORY MUSCLE DYSFUNCTION AND CHRONIC HYPERCAPNIA IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
    BEGIN, P
    GRASSINO, A
    [J]. AMERICAN REVIEW OF RESPIRATORY DISEASE, 1991, 143 (05): : 905 - 912
  • [3] FORCE RESERVE OF THE DIAPHRAGM IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
    BELLEMARE, F
    GRASSINO, A
    [J]. JOURNAL OF APPLIED PHYSIOLOGY, 1983, 55 (01) : 8 - 15
  • [4] Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy
    Bingisser, R
    Zollinger, A
    Hauser, M
    Bloch, KE
    Russi, EW
    Weder, W
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1996, 112 (04) : 875 - 882
  • [5] STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
    BLAND, JM
    ALTMAN, DG
    [J]. LANCET, 1986, 1 (8476) : 307 - 310
  • [6] Bland M., 1987, INTRO MED STAT
  • [7] BLOCH KE, 1995, AM J RESP CRIT CARE, V151, P1087
  • [8] FORCE-LENGTH RELATIONSHIP OF THE NORMAL HUMAN DIAPHRAGM
    BRAUN, NMT
    ARORA, NS
    ROCHESTER, DF
    [J]. JOURNAL OF APPLIED PHYSIOLOGY, 1982, 53 (02) : 405 - 412
  • [9] Brooks S. M., 1982, American Review of Respiratory Disease, V126, P952
  • [10] BILATERAL PNEUMECTOMY (VOLUME REDUCTION) FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
    COOPER, JD
    TRULOCK, EP
    TRIANTAFILLOU, AN
    PATTERSON, GA
    POHL, MS
    DELONEY, PA
    SUNDARESAN, RS
    ROPER, CL
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 109 (01) : 106 - 119