Lungenfunktion, Gasaustausch und Atemregulation bei Patienten mit portokavaler Enzephalopathie

Abstract

In 17 patients, breathing room air and pure oxygen, with histologically proven cirrhosis of the liver and portocaval encephalopathy grade I, static and dynamic lung volumes, closing capacity and arterial blood gases were determined. Furthermore, CO₂response curves were provided and mouth occlusion pressure measurements were carried out. The residual volume was found to be increased (130 ± 8% of predicted) which resulted in decreased vital capacity (79 ± 2% of predicted) with total lung capacity being normal (94 ± 2% of predicted). Closing capacity was increased to 134 ± 5% of the predicted value. Gas exchange for oxygen was impaired (AaDO₂= 262 ± 30% of predicted). Arterial Po₂, however, was within normal range Pao₂ = 84 ± 3.6 mm Hg) due to hyperventilation (Paco₂= 28.1 ± 0.8 mmHg). Hypoxic ventilatory stimulation could be excluded because inspiration of pure oxygen caused no change of Paco₂ (Paco₂ = 27.3 -f 0.7 mm Hg and Pao₂ = 465 + 16.9 mm Hg with Fιo₂ = 1.0). The slope of the CO₂ response curves was normal, the mouth occlusion pressures, however, were higher than the predicted value: up to Paco₂ of 55 mm Hg. The slope of these curves being smaller than predicted. The results show that in patients with portocaval encephalopathy the lung function is disturbed due to premature airway closure with consequently decreased regional ventilation: perfusion ratios and that regulation of ventilation is impaired by a loss of sensitivity for CO, with high basal output of the respiratory centers not related to CO₂

Hypoxemia in Infants with Biliary Atresia

“…In other studies, MEF25-75 was decreased (6,23,24). Closing capacity and closing volume were described to be elevated (24)(25)(26)(27), and re-sidual volume was increased , especially in the lower zones of the lung (26).…”

Störungen der Atmung bei Patienten vor und nach Lebertransplantation

“…Respiratorische Alkalose, Störungen des Gasaustausches, Hypoxämie [11], in trapulmonale Shunts [17], VentilationsPerfusions-Missverhältnis [12], Erniedri gung der Diffusionskapazität [27], Erhö hung des «closing volume» [12] und Ver änderungen der «closing capacity» [11,12] sowie Pleuraergüsse sind in der Litera tur als Manifestationen der gestörten At mung bei chronischen Lebererkrankun gen beschrieben worden [15,16,24,34] …”