Ventilation and perfusion of the lungs

Regional ventilation and lung perfusion were studied using reopulmonography. MEP of the right lung: in the upper zone – 8.3, in the middle zone – 7.8; in the lower zone – 7.2 ohm / min; MOPP of the left lung: in the upper zone – 8.1, in the middle zone – 7.7; in the lower zone – 7.6 ohm / min. MOVr sum = 46.7 ohm / min. The ratio of MOV of the upper zones / MOV of the lower zones = 1.1, which indicates a significant redistribution of ventilation from the lower zones of the lungs to the upper ones. MPCr of the right lung: in the upper zone – 10, in the middle zone 8.2, in the lower zone 6.8; MPCr of the left lung: in the upper zone – 9, in the middle zone 8.6, in the lower zone 6.1 Om / min; MPKr sum 48.7 ohm / min. Reprinted pulmonary blood flow from the lower zones to the upper ones due to the increase in vascular resistance in the lower and middle zones and its decrease in the upper zones. VPO were distributed as follows: right lung – upper zone 0.83, middle zone 0.95, lower zone 1.0; left lung – upper zone 0.9, middle zone – 0.9, lower zone 1.2. The total index of the HPE of the right lung is 0.9, the left lung is 1, both lungs are 0.95. The data of ultrasound IWC: SrDLA – 24 mm. Hg Art., KDO PZh – 135 ml, CSR PZh – 51 ml, UI PZh – 72 ml / m 2 , SI PZH – 4.3 l / min / m 2 , EF RV – 54%, E TK – 0.44 m / s, A TK 0.70 m / s, E / A – 0.63. Diagnosed the expansion of all cavities of the heart. Ultrasonic examination of the diaphragm: TD – 5 mm, EDS – 8 mm, EDf – 13 mm. A decrease in the excursion of the diaphragm with quiet and forced breathing was diagnosed, which is due to its compression by significantly increased liver and spleen.

After analyzing the data of spirography, peak flow measurements, pneumotachography, and zonal rheography of the lungs, these studies of endobronchial LDF, pulmonary and intracardiac hemodinamics in patients with CLL, we can conclude:

1. In the process of tumor progression in CLL, indices of endobronchial microhemocirculation decrease. Important causes of endobronchial microcirculation disorders in CLL are high leukocytosis in the peripheral blood, contributing to the formation of leucostasis; in patients with anemic syndrome, a decrease in the number of erythrocytes.

2. Disruption of microhemocirculation in patients with CLL contributes to disruption of tissue trophism, development of tissue hypoxia, local metabolic disorder, resulting in the onset of a severe and prolonged inflammatory process in the lungs and bronchi and an increase in pressure in the small circle of the circulation. When conducting a fibrobronchoscopic study in 60% of patients with a progressive course of CLL, the latent course of chronic non-obstructive bronchitis was diagnosed (40% of the total number of CLL patients).

3. As the tumor process develops in CLL, violations of general and regional ventilation and lung perfusion are progressed, which is characterized by a decrease in these indicators in each zone separately and in general in both lungs. There is a redistribution of ventilation and blood flow from the lower and middle zones to the upper zones of both lungs. These changes are due to the presence of infectious complications and leukemic bronchopulmonary manifestations of CLL, a violation of the diaphragm excursion.

4. In patients with CLL in the later stages of the tumor progression, bronchial resistance increases due to severe and severe inflammatory processes, leukemic infiltration of the lungs and bronchi, impaired endobronchial micro-hemocirculation, compression of the bronchial tree by increased mediastinal lymph nodes.

5. As the CLL progresses, there are impaired systolic and diastolic functions of the right and left ventricles.

6. Violation of the contractile ability of the diaphragm in patients with CLL is promoted by its leukemic lesion and compression by the enlarged liver and spleen.

7. In 37% of patients with CLL in the late stages of tumor progression without a concomitant broncho-obstructive process, hypoxemia and pulmonary hypertension are diagnosed. A disturbance in the expansion of the diaphragm, a severe course of infectious complications and leukemic lesions of the bronchopulmonary system, rheological disorders in the ICC vessels, and myocardial dystrophy contribute to an increase in pressure in the LA system in these patients.

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