Anatomical backgrounds on gas exchange parameters in the lung  

作　　者：Kazuhiro Yamaguchi Takao Tsuji Kazutetsu Aoshiba Hiroyuki Nakamura Shinji Abe 

机构地区：[1]Department of Respiratory Medicine, Tokyo Medical University [2]Department of Respiratory Medicine, Tokyo Medical University, Ibaraki Medical Center

出　　处：《World Journal of Respirology》2019年第2期8-29,共22页世界呼吸病学杂志

摘　　要：Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit.Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung periphery.However, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anatomically morbid states in alveolar walls:type-1aMany problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit.Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung periphery.However, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anatomically morbid states in alveolar walls:type-1a

关 键 词：Secondary lobule of MILLER ACINUS of Loeschcke ACINUS of Aschoff Convection GAS-PHASE diffusion(stratification) AQUEOUS-PHASE DIFFUSION Ventilationperfusion heterogeneity 

分 类 号：R[医药卫生]