从整体整合生理学医学新理论看弥散功能-DLCO解读中的误区*

doi:10.12047/j.cjap.0119.2015.014

摘要/Abstract

摘要： 目的: 从整体整合生理学来看,气体弥散功能取决于呼吸系统和循环系统的功能正常,以及二者之间良好的匹配。但传统系统生理学把弥散功能单纯划归为肺功能指标来分析和解读。由于忽略了循环系统的作用,D_LCO判读可能会产生误区。方法: 依据新创立的整体整合生理学医学理论构架,以呼吸、循环和代谢等系统为核心,在神经体液的调控下,以呼吸和循环优化匹配为基础,进行对于弥散功能的解读探讨。特别是心衰状态对弥散功能的影响进行分析和探讨。结果: 理论上弥散功能取决于呼吸和循环以及它们的正常匹配。对于心衰患者的病理生理改变的特点以及在心衰条件下可产生的心源性弥散功能障碍进行分析和推测。结论: 弥散功能的正常取决于正常的呼吸和循环以及它们的良好匹配。在心衰患者中呼吸和循环匹配差,虽然左心泵血功能的受限,在一定程度上使得肺血容量增大,但是同时肺血流速度降低,肺弥散膜厚度增厚和弥散距离增加,推测得出结论——心衰患者气体弥散功能应该降低而非增高。

关键词: 气体弥散功能, 肺功能, 整体整合生理学, 呼吸, 循环, 代谢

Abstract: Objective: From the point of holistic integrative medicine,the D_LCO depends on not only normal respiratory and circulatory functions, but also an optional matching between them. However, due to the limitation of traditional systemic physiology, the D_LCO always be classified as lung functional parameter to be analyzed and interpreted. Because ignoring the circulatory system function, so it will certainly have some misunderstandings. Methods: Based on the Holistic Integrative Medicine, under the control of neurohumoral, respiratory, circulatory and metabolic systems work together, we discussed the diffusion function. We analyzed the change of D_LCO in the patients with cardiac dysfunction, especially the heart failure. Results: The D_LCO, CO gas diffusion from lung circulating blood, depends on the normality of respiratory and circulatory systems and their matching.We analyzed the reasons of D_LCO for characteristic pathophysiological changes of patients with heart failure. Conclusion: The normal D_LCO depends on a good matching of normal respiratory and circulatory systems. For heart failure, the respiratory and circulatory systems matching is poor. Due to dominant limitation of left ventricle pump function, pulmonary blood volume may slightly increased, but combination of all reduced pulmonary blood flow rate, thicked diffuse member and increased diffusion distance etc. suggest that patients with heart failure should have a decreased, rather than increased, D_LCO.

Key words: diffusing capacity of gas, lung function, holistic integrative physiology, respiratory, circulation, metablism

中图分类号:

R448

孙兴国. 从整体整合生理学医学新理论看弥散功能-D_LCO解读中的误区^*[J]. 中国应用生理学杂志, 2015, 31(4): 353-356.

SUN Xing-guo. An misunderstanding in traditional interpretation of D_LCO[J]. CJAP, 2015, 31(4): 353-356.

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