Atemmechanische Untersuchungen zur Frage der Ventilationsbehinderung bei Patienten mit chronisch obstruktiver Atemwegserkrankung
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Zusammenfassung
21 Personen von verschiedenem Alter mit und ohne Atemwegsobstruktion wurden untersucht. Strömung der Atemluft, Gasvolumen, Alveolar- und Oesophagusdrucke wurden wäuhrend Ausatmung nach normaler wie tiefer Inspiration simultan gemessen.
Zwischen acetylcholininduzierten Atemwegsobstruktionen bei gesunden Versuchspersonen und bei Patienten mit chronischer Atemwegsobstruktion waren nur geringe, wahrscheinlich auf den Umbau der Lunge zurückzuführende, unterschiedliche Verhaltensweisen nachweisbar.
Mit abnehmendem Lungenvolumen und Zunahme des Oesophagusdruckes nahmen die Strömungswiderstände in den Atemwegen bei den Patienten mit Atemwegsobstruktion viel stärker und früher als bei gesunden Versuchspersonen zu.
Die Strömungswiderstände in den Atemwegen sind vom Intrapleuraldruck, dem Lungenvolumen, dem Alveolardruck und dem Tonus der Bronchialmuskulatur abhängig, wobei dem Tonus der Bronchialmuskulatur und dem Lungenvolumen überragende Bedeutung zukommen.
Zwischen dem lungenvolumenabhängigen Alveolardruck, Intrapleuraldruck und Bronchialmuskeltonus besteht Druckgleichgewicht, welches die Strömungswiderstände in den Atemwegen bestimmt.
Vollständiger Verschluß von Atemwegen in Abhängigkeit vom Ausmaß des Muskeltonus und der Dehnungslage der Lunge ist mit kleiner werdenden Lungenvolumina während der Ausatmung anzunehmen.
Mechanics of breathing: Airway flow resistance in patients with chronic obstruction
Abstract
21 subjects of different age groups with and without airway obstruction were studied. The simultaneous parameters were airflow, intrathoracic gas volume, alveolar and oesophageal pressure during maximum possible expiration after normal and deep inspiration.
The differences in healthy subjects with acetylcholine-induced airway obstruction and in patients with chronic airway obstruction were very small; possibly, these differences were due to general destructive changes of the lung parenchyma.
The increase of airway flow-resistance, with the decrease of lung-volume and with the increase of oesophageal pressure, were more marked and earlier in patients with airway obstruction than in healthy subjects. The flow-resistance forces in airways are dependent on intrapleural- and alveolar-pressure, on lung volume and on the tension of the bronchial musculature, in which the bronchial muscle tension and lung volume play a more prominent role.
The airway flow resistance is controlled by the balance between the volume dependent, alveolar- and intrapleural pressure, and bronchial muscle tension.
The tendency of the total closing of the airways with the decrease of lung volume during deep expiration is dependent on the tension of the bronchial musculature and the volume of the lung.
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