The amplitude of oscillations in the C-band, brought into the microcirculatory bed from the arteries, was reduced compared with the control. A decrease in the amplitude of oscillations in the C-band indicates a decrease in the flow of arterial blood into the microvasculature. This may be due to microcirculation disorders in the bronchi in patients with CLL, a large role, in the development of which belongs to the presence of leucostasis. In many patients, peripheral blood leukocytosis of more than 100 × 10 9 / l was observed . It must be borne in mind that in patients with CLL, outside the attachment of AML, during the tumor progression, a decrease in the C-band oscillation amplitudes is diagnosed. At the same time, in patients with COPD, without concomitant hemoblastosis, no changes in cardiac fluctuations were diagnosed .
4 weeks after initiation of COPD therapy, these patients were given endobronchial LDF again . The PM indicator remained significantly reduced. The values of σ and Kv did not undergo significant changes. The amplitude of endothelial oscillations increased slightly and did not have significant differences with the control (in contrast to the initial indicator). The amplitude of oscillations in the neurogenic range remained elevated. The amplitude of cardiac oscillations remained almost unchanged and was reduced. The amplitudes of oscillations in the myogenic and respiratory ranges did not significantly change. Etc. oanalizirovav WMS data but to conclude that significant changes in the microcirculatory blood flow in the mucous membrane of the proximal bronchi in patients with COPD associated with CLL remain, even if the bronchoscopic picture improves. This may be due, primarily, to the presence of lymphocytic leukemia, in which initially there are places of significant impairment of micro hemocirculation. In many patients with CLL, without a concomitant broncho-obstructive process, PM, Ac are significantly reduced . Disorders of microhemocirculation contribute to the recurrence of severe and prolonged inflammatory processes in the lungs and bronchi, resulting in an increase in pressure in the pulmonary circulation.
The gas composition of blood was studied in patients with COPD flowing on the background of CLL and COPD without an associated lymphoproliferative disease. In the main group, there was a significant increase in pCO 2 , a decrease in pO 2 and capillary blood pH, as compared with the control. Indicators of blood gas composition in patients of the main and third control groups did not have significant differences.
Clinical and radiological manifestations of pulmonary emphysema were diagnosed in 40 patients with COPD. The clinical manifestations of emphysema in these patients were the following symptoms: the chest is cylindrical barrel-shaped, the lower borders of the lungs are lowered by one or two ribs, the smoothness of the supraclavicular depressions, expansion and bulging of the intercostal spaces, reduction of the respiratory excursion of the lungs, boxed sound over the entire lung surface , with auscultation, weakened breathing, reduction of cardiac dullness, visible pulse tion in the epigastric region. All of these patients had shortness of breath, aggravated by exertion, and increased fatigue. In patients with pulmonary emphysema, a significant loss of body weight was observed. However, in patients with CLL, with a rapidly progressive course of the disease and in the terminal stage, cachexia may be a manifestation of hemoblastosis.
The radiographic signs of emphysema were as follows: barrel-shaped or bell-shaped chest with horizontally extending posterior rib segments and extended intercostal spaces; the vertical size of the chest is enlarged, the sternum is deflected anteriorly, the retrosternal space “gapes” (more than 3-5 cm); an increase in the area and transparency of the pulmonary fields; discharge, impoverishment of the pulmonary pattern; in the inspiratory position low aperture; costal diaphragmatic sinuses flattened, deployed; the excursion of the domes of the diaphragm is sharply reduced. The most reliable radiological signs of pulmonary emphysema are detected by X-ray computed tomography .
During spirography, there was a decrease in VC (48 ± 5.2% D), an increase in the functional residual capacity of the lungs, and a residual volume. Mild emphysema (residual volume of 35–45%) was diagnosed in 21 patients, severe (45–50%) in 11 patients and severe (over 55%) in 8 people.
It should be noted that the number of patients diagnosed with some clinical and radiological signs of emphysema (98 people, including 40 patients with emphysema caused by COPD) is greater than the number of patients with emphysema in COPD (Chapter 3). This is due to the elderly patients with CLL, in this situation there is a so-called. senile emphysema. Unlike true emphysema, in patients with COPD, the air capacity of the lungs in these patients did not decrease, pulmonary hypertension and right ventricular hypertrophy did not develop.