Regionale Lungenfunktion bei Patienten mit arterieller Hypertonie

Zusammenfassung

Die regionale Lungenfunktion wurde bei 23 Patienten mit arterieller Hypertonie ohne Herzinsuffizienz mit radioaktivem 133Xenon untersucht.

Im Vergleich zu einer Kontrollgruppe, die aus 16 Gesunden im selben Alter bestand, wurden bei den meisten Hypertonikern folgende Veränderungen gefunden: 1. Verkleinerung der physiologischen Inhomogenität in der Verteilung des Perfusionsindex mit Verminderung der Differenz zwischen oberen und unteren Lungenregionen, unabhängig von der Höhe des Blutdrucks; 2. Vergrößerung der physiologischen Inhomogenität in der Verteilung des Ventilationsindex mit Erhöhung der Differenz zwischen oberen und unteren Lungenregionen; diese Tendenz war besonders bei der essentiellen Hypertonie erkennbar und war bei den Patienten stärker ausgeprägt, deren systolischer Blutdruck verhältnismäßig niedrig war; 3. Erhöhung des Ventilations-Perfusions-Quotienten in den unteren und Verminderung in den oberen Lungenteilen; 4. Erhöhung des prozentualen Anteils des Residualvolumens an der Totallungenkapazität in allen Regionen, besonders aber in den unteren, was vor allem bei Patienten mit nephrogener Hypertonie auffiel.

Regional lung function was studied in 23 patients with arterial hypertension without heart failure, using ¹³³Xe and a gamma camera.

In comparison with a control group, consisting of 16 healthy people of the same age, the following changes were found in hypertensive patients:

1. A decrease in the physiological non-uniformity of the distribution of the perfusion index with a reduction of the difference between the upper and lower parts of the lungs. This change was independent of the level of the arterial pressure;

2. An increase in the physiological unevenness of the distribution of the ventilation index with an enlargement of the difference between the upper and lower parts of the lungs. This tendency was especially visible in essential hypertension and was more prominent in patients with relatively low systolic blood pressure;

3. An increase in the ventilation-perfusion-quotient in the lower and a decrease in the upper parts of the lungs;

4. An increase in the percentage of residual volume in proportion to the total lung capacity in all regions, especially in the lower parts. This change was particularly visible in patients with renal hypertension.

^* Stipendiatin der Alexander von Humboldt-Stiftung.

• Literatur

• 1 Anthonisen N. R, Milic- Emili J. Distribution of pulmonary perfusion in erect man. J. Appl. Physiol 1966; 21: 760.
• 2 Attinger E. O, Goldstein M. M, Segal M. S. The mechanics of breathing in normal subjects and patients with cardiopulmonary disease. Ann. Intern. Med 1958; 48: 1269.
• 3 Ball Jr. W. C, Stewart P. B, Newsham L. G. S, Bates D. V. Regional pulmonary function studied with ¹³³xenon. J. Clin. Invest 1962; 41: 519.
• 4 Bello C. T, Sevy R. W, Harakal C. Varying hemodynamic patterns in essential hypertension. Amer. J. Med. Sei 1965; 250: 24.
• 5 Bjure J. Distribution of ventilation and perfusion at rest and during exercise. Scand. J. Resp. Dis. suppl 1971; 77: 36.
• 6 Boesten R, Tarkowska A. Untersuchung der regionalen Lungenfunktion mit dem radioaktiven ¹³³Xenon. Nuclear-Medizin, im Druck.
• 7 Bryan A. C, Bentivoglio L. G, Beerel F, Macleish H, Zidulka A, Bates D. V. Factors affecting regional distribution of ventilation and perfusion in the lung. J. appl. Physiol 1964; 19: 395.
• 8 Brown C. C, Frey D. L, Ebert R. V. The mechanics of pulmonary ventilation in patients with heart disease. Amer. J. Med 1954; 17: 438.
• 9 Dawson A, Kaneko K, McGregor M. Regional lung function in patients with mitral stenosis studied with ¹³³xenon during air and oxygen brathing. J. Clin. Invest 1965; 44: 999.
• 10 Doll E, Keul J. Die Beeinträchtigung der Lungenfunktion bei der Linksinsuffizienz des Herzens. Ärztl. Forsch 1968; 22: 123.
• 11 Dollery C. T, West J. B. Regional uptake of radioactive oxygen, carbon monoxide and carbon dioxide in the lungs of patients with mitral stenosis. Circulation Research 1960; 8: 765.
• 12 Finkielman S, Worcel M, Agrest A. Hemodynamic patterns in essential hypertension. Circulation 1965; 31: 356.
• 13 Foëx P, Meloche R, Prys-Roberts C. Studies of anaesthesia in relation to hypertension. Ill: pulmonary gas exchange during spontaneous ventilation. Brit. J. Anaesth 1971; 43: 644.
• 14 Freis E. D. Hemodynamics of hypertension. Physiol. Rev 1960; 40: 27.
• 15 Frohlich E. D, Tarazi R. C, Dustan H. P. Re-examination of the hemodynamics of hypertension. Amer. J. Med. Sei 1969; 257: 9.
• 16 Frohlich E. D, Tarazi R. C, Dustan H. P. Hemodynamic and functional mechanisms in two renal hypertensions: arterial and pyelonephritis. Amer. J. Med. Sei 1971; 261: 189.
• 17 Frohlich E. D, Tarazi R. C, Ulrych M, Dustan H. P, Page I. H. Tilt test for investigatinga neural component in hypertension. Its correlation with clinical characteristics. Circulation 1967; 36: 387.
• 18 Fröhlich E. D, Ulrych M, Tarazi R. C, Dustan H. P, Page I. H. A hemodynamic comparison of essential and renovascular hypertension. Cardiac output and total peripheral resistance supine and tilted patients. Circulation 1967; 35: 289.
• 19 Fröhlich E. D, Ulrych M, Tarazi R. C, Dustan H. P, Page I. H. Hemodynamics of renal arterial diseases and hypertension. Amer. J. Med. Sei 1968; 29: 255.
• 20 Hamm J, Schölmerich P. „Uber Lungenschwellung und Lungenstarrheit": Atemmechanische Untersuchungen an 100 Mitralstenosen. Klin. Wschr 1964; 42: 1108.
• 21 Heyer H. E. Abnormalities of the respiratory pattern in patients with cardiac dyspnea. Amer. Heart J 1946; 32: 457.
• 22 Jebavý P, Runczik I, Oppell A, Tilsch J, Staněk V, Widimský J. Regional pulmonary function in patients with mitral stenosis in relation to haemodynamic data. Brit. Heart J 1970; 32: 330.
• 23 Julius S, Conway J. Hemodynamic studies in patients with borderline blood pressure elevation. Circulation 1968; 38: 282.
• 24 Kaneko K, Milic-Emili J, Dolovich M. B, Dawson A, Bates D. V. Regional distribution of ventilation and perfusion as a function of body position. J. Appl. Physiol 1966; 21: 767.
• 25 Konietzko N, Rühle K. H, Sigm E, Overrath G, Spilker D, Matthys H, Adam W. E. Investigation of the lung function using inert radioactive gases. In: Dynamic studies with radioisotopes in medicine. IAEA; Vienna: 1971
• 26 Laver M. B, Hallowell P, Goldblall A. Pulmonary dysfunction secondary to heart disease. Anaesthesiology 1970; 33: 161.
• 27 Ledingham J. M, Cohen R. D. The role of the heart in the pathogenesis of renal hypertension. Lancet 1963; II: 979.
• 28 Lohmann F. W, Götzen Th Dissmann R, Molzahn M, Oelkers W. Plasmakatecholamine, Reninkonzentration, kreislaufmechanische Befunde und N: erenfunktion sowie ihre Veränderungen durch Orthostase bei Patienten mit renovaskulärer Hypertonie. Verh. dtsch. Ges. inn. Med 1971; 77: 121.
• 29 Mannell T. J, Prime F. J, Smith D. W. A practical method of using radioactive xenon for investigating regional lung funcron. Scand. J. Resp. Dis. suppl 1966; 62: 41.
• 30 Milic-Emili J, Henderson J. A. M, Dolovich M. B, Trop D, Kaneko K. Regional distribution of inspired gas in the lung. J. Appl. Physiol 1966; 21: 749.
• 31 Miörner G. ¹³³Xe-Radiospirometry. A clinical method for studying regional lung function. Scand. J. Resp. Dis. 1968. Suppl 64.
• 32 Pirincci A, Kass I, Denst J, Hoffman M. S. Severe reactive pulmonary hypertension secondary to aortic stenosis. Amer. J. Med. Sei 1961; 241: 343.
• 33 Rühle K.-H, Spilker D, Sigm E, Konietzko N, Overrath G, Matthys H, Adam W. E. Lungenfunktionsdiagnostik mit radioaktiven Edelgasen. Ges. für Nuklearmedizin; Hannover, Mitteil: 1970: 98.
• 34 Sannerstedt R. Hemodynamic findings at rest and during exercise in mild arterial hypertension. Amer. J. Med. Sei 1969; 258: 70.
• 35 Tarazi R. C, Dustan H. P, Fröhlich E. D, Gifford R. W, Hoffman G. C. Plasma volume and chronic hypertens'on. Relationship to arterial pressure levels in different hypertensive diseases. Arch. Intern. Med 1970; 125: 835.
• 36 Ulrych M, Fröhlich E. D, Tarazi R. C, Dustan H. P, Page I. H. Cardiac output and distribution of blood volume in central and peripheral circulations in hypertensive and normotensive man. Brit. Heart J 1969; 31: 570.
• 37 West J. B. Distribution of pulmonary blood flow and ventilation measured with radioactive gases. Scand. J. Resp. Dis. suppl 1966; 62: 9.
• 38 West J. B, Dollery C. T, Naimark A. Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J. Appl. Physiol 1964; 19: 713.
• 39 Widimsky J, Fejfarová M. H, Fejfar Z. Changes of cardiac output in hypertensive disease. Cardiologia (Basel) 1957; 31: 381.