Impaired ventilation function of the lungs according to the restrictive type. Respiratory failure (Pulmonary failure) Impaired pulmonary ventilation of mixed type

Restrictive respiratory failure may be caused by: 1. diseases of the pleura, limiting the excursion of the lung ( exudative pleurisy, hydrothorax, pneumothorax, fibrothorax, etc.);

2. reduction in the volume of functioning lung parenchyma(atelectasis, pneumonia, lung resection and etc.);

3. inflammatory or hemodynamically caused infiltration of lung tissue, leading to an increase in the “stiffness” of the pulmonary parenchyma (pneumonia, interstitial or alveolar pulmonary edema with left ventricular heart failure, etc.);

4. pneumosclerosis of various etiologies;

5. defeats chest(deformations, kyphoscoliosis) and respiratory muscles (myositis).

It should be noted that in many respiratory diseases there is a combination of restrictive and obstructive disorders, as well as disruption of the processes of lung perfusion and gas diffusion through the alveolar-capillary membrane. Nevertheless, it is always important to assess the prevailing mechanisms of pulmonary ventilation impairment, obtaining objective justification for prescribing one or another pathogenetic therapy. Thus the following tasks arise:

1. Diagnosis of dysfunctions external respiration and objective assessment of the severity of respiratory failure.

2. Differential diagnosis of obstructive and restrictive pulmonary ventilation disorders.

3. Rationale for pathogenetic therapy of respiratory failure.

4. Evaluation of the effectiveness of the treatment.

These problems are solved both in the study of respiratory function, including spirography and pneumotachography, and using more complex methods, allowing to study indicators of the mechanics of breathing and gas exchange in the lungs.

Spirography is a method of graphically recording changes in lung volumes when performing various respiratory maneuvers, with the help of which pulmonary ventilation indicators, lung volumes and capacities (a capacity includes several volumes) are determined.

Pneumotachography is a method of graphically recording flow (volumetric air velocity) during quiet breathing and when performing certain maneuvers. Modern spirometric equipment (spirometers) makes it possible to determine spirographic and pneumotachometric indicators. In this regard, increasingly, the results of studying the function of external respiration are combined under one name - “spirometry”.

Mixed ventilation disorders lungs. Purely obstructive and restrictive disorders of pulmonary ventilation are possible only theoretically. There is almost always some combination of both types of ventilation disturbances.

Damage to the pleura leads to the development of restrictive pulmonary ventilation disorders due to the following reasons: 1) pain in the chest; 2) hydrothorax; 3) hemothorax; 4) pneumothorax; 5) pleural moorings.

Under the influence of pain, the respiratory excursion of the chest is limited. Pain occurs with inflammation of the pleura (pleurisy), tumors, wounds, injuries, intercostal neuralgia and etc.

Hydrothorax- fluid in the pleural cavity, causing compression of the lung, limiting its expansion (compressive atelectasis). With exudative pleurisy, exudate is detected in the pleural cavity; with pulmonary suppuration, pneumonia, the exudate can be purulent; with insufficiency of the right heart in pleural cavity transudate accumulates. Transudate in the pleural cavity can also be detected in edematous syndrome of various natures.

Hemothorax- blood in the pleural cavity. This can happen with chest injuries, pleural tumors (primary and metastatic). In case of lesions of the thoracic duct, chylous fluid is detected in the pleural cavity (contains lipoid substances and appearance resembles milk). In some cases, the so-called pseudochyle fluid, a cloudy whitish fluid that does not contain lipoid substances, can accumulate in the pleura. The nature of this liquid is unknown.

Pneumothorax- gas in the pleural area. There are spontaneous, traumatic and therapeutic pneumothorax. Spontaneous pneumothorax occurs suddenly. Primary spontaneous pneumothorax can develop in almost healthy person during physical stress or at rest. The causes of this type of pneumothorax are not always clear. Most often it is caused by rupture of small subpleural cysts. Secondary spontaneous pneumothorax also develops suddenly in patients against the background of obstructive and non-obstructive lung diseases and is associated with the breakdown of lung tissue (tuberculosis, lung cancer, sarcoidosis, pulmonary infarction, cystic pulmonary hypoplasia, etc.). Traumatic pneumothorax is associated with a violation of the integrity of chest wall and pleura, lung injury. Therapeutic pneumothorax in last years rarely used. When air enters the pleural cavity, atelectasis of the lungs develops, the more pronounced the more gas is in the pleural cavity.

Pneumothorax can be limited if in the pleural cavity there are adhesions of the visceral and parietal layers of the pleura as a result of an inflammatory process. If air enters the pleural cavity without restriction, complete collapse of the lung occurs. Bilateral pneumothorax has a very poor prognosis. If the access of air into the cavity is not limited in any way, complete collapse of the left and right lungs occurs, which is, of course, a fatal pathological condition. However, partial pneumothorax has a serious prognosis, since it disrupts not only the respiratory function of the lungs, but also the function of the heart and blood vessels. Pneumothorax can be valvular, when during inspiration air enters the pleural cavity, and during exhalation the pathological opening closes. The pressure in the pleural cavity becomes positive, and it increases, squeezing the functioning lung and more significantly disrupting the function of the heart and blood vessels. In such cases, disturbances in pulmonary ventilation and blood circulation quickly increase and can lead to the death of the patient if he is not provided with qualified assistance.

The condition when there is both liquid and gas in the pleural cavity is called hydropneumothorax. This happens when a lung abscess breaks through into the bronchus and pleural cavity.

Pleural moorings are a consequence of inflammatory damage to the pleura. The severity of moorings can vary: from moderate to the so-called armored light.

Impairments in the ventilation capacity of the lungs, which are based on an increase in resistance to air movement through the respiratory tract, i.e., impairment of bronchial obstruction. Disturbances in bronchial obstruction can be caused by a number of reasons: bronchospasm, edematous-inflammatory changes bronchial tree(swelling and hypertrophy of the mucosa, inflammatory infiltration of the bronchial wall, etc.), hypersecretion with accumulation of pathological contents in the lumen of the bronchi, collapse of small bronchi when the lungs lose their elastic properties, pulmonary emphysema, tracheobronchial dyskinesia, collapse of large bronchi during exhalation. In chronic nonspecific lung pathology, an obstructive variant of disorders is often found.

The main element of obstruction is the difficulty of exhalation. On the spirogram, this is manifested in a decrease in the volumetric flow rate of forced expiration, which primarily affects such an indicator as FEV1.

Ventilation disorders

Vital capacity of the lungs during obstruction for a long time remains normal, in these cases the Tiffno test (FEV1/VC) is reduced to approximately the same extent (by the same percentage) as FEV. With prolonged obstruction, with prolonged asthmatic conditions accompanied by acute bloating of the lungs, especially with emphysema, obstruction leads to an increase in residual lung volume. The reasons for the increase in total volume during obstructive syndrome lie in the unequal conditions of air movement through the bronchi during inhalation and exhalation. Since the resistance on exhalation is always greater than on inhalation, exhalation is delayed, lengthened, emptying the lungs is difficult, the flow of air into the alveoli begins to exceed its expulsion from the alveoli, which leads to an increase in the total volume. An increase in TLC can occur without a decrease in VC, due to an increase in total lung capacity (TLC). However, often, especially in elderly patients, the possibilities of increasing TLC are small, then the TLC begins to increase due to a decrease in VC. In these cases, the spirogram becomes characteristics: low forced expiratory volumetric flow rates (FEV1 and MOS) are combined with a small volume of vital capacity. The relative indicator, the Tiffno index, in these cases loses its information content and may turn out to be close to normal (with a significant decrease in vital capacity) and even quite normal (with a sharp decrease in vital capacity).

Considerable difficulties in spirographic diagnosis present recognition of the mixed variant, when elements of obstruction and restriction are combined. At the same time, on the spirogram there is a decrease in vital capacity against the background of low volumetric velocities of forced expiration, i.e., the same picture as with advanced obstruction. Differential diagnosis obstructive and mixed variants can be helped by measuring the residual volume and total lung capacity: with a mixed variant low values FEV| and VC are combined with a decrease in TLC (or with normal TLC); with the obstructive variant, the TLC increases. In all cases, the conclusion about the presence of factors limiting lung expansion against the background of obstructive pathology should be made with caution.

At the core restrictive(from lat. restrictio

cause a decrease in respiratory surface area and/or a decrease in lung compliance. Such causes are: pneumonia, benign and malignant tumors, tuberculosis, lung resection, atelectasis, alveolitis, pneumosclerosis, pulmonary edema(alveolar or interstitial), impaired formation of surfactant in the lungs, damage to the elastin of the pulmonary interstitium (for example, due to exposure to tobacco smoke).

FVD – disorders of the ventilation function of the lungs of a mixed, obstructive-restrictive type.

With a decrease in the formation or destruction of surfactant, the ability of the lungs to stretch during inspiration decreases, which is accompanied by an increase in the elastic resistance of the lungs. As a result, the depth of inspiration decreases and the respiratory rate increases. Shallow, rapid breathing occurs (tachypnea).

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Restrictive breathing disorders

At the core restrictive(from lat. restrictio– limitation) of pulmonary ventilation disorders lies in the limitation of their expansion in the inhalation phase as a result of intrapulmonary and extrapulmonary causes. It is based on changes in the viscoelastic properties of lung tissue.

Intrapulmonary causes of restrictive type of alveolar hypoventilation

Extrapulmonary causes of restrictive type of alveolar hypoventilation lead to a limitation in the magnitude of chest excursions and a decrease in tidal volume (TV). Such reasons are: pathology of the pleura, diaphragm, impaired mobility of the chest and impaired innervation of the respiratory muscles.

Of particular importance in the development of extrapulmonary forms of restrictive disorders of external respiration is the pleural cavity, the accumulation of exudate or transudate in it (with hydrothorax), the entry of air into it (pneumothorax), and the accumulation of blood in it (hemothorax).

Impaired ventilation

Hypoventilation disorders of the restrictive type are characterized by a decrease in static volumes (VC, FRC, TLC) and a decrease driving force expiratory flow. The function of the airways remains normal, therefore, the air flow speed does not change. Although FVC and FEV1 decrease, the FEV1/FVC% ratio is within normal values or increased. In restrictive pulmonary disorders, lung compliance (∆V/∆P) and elastic recoil of the lungs are reduced. Therefore, the volumetric rate of forced expiration SOS25-75 (averaged value over a certain period of measurements from 25% to 75% FVC) decreases even in the absence of airway obstruction. FEV1, which characterizes the volumetric expiratory flow rate, and the maximum expiratory flow rate in restrictive disorders is reduced due to a decrease in all pulmonary volumes (VC, FUEL, TLC).

Hypoventilation breathing disorders often occur due to dysfunction of the respiratory center and breathing regulation mechanisms. They, due to disruption of the respiratory center, are accompanied by gross disturbances of rhythmogenesis, the formation pathological types breathing, development of apnea.

There are several forms of disruption of the respiratory center depending on the disorder of afferentation.

1. Deficiency of excitatory afferent influences on the respiratory center (with immaturity of chemoreceptors in premature newborns; in case of poisoning drugs or ethanol, with Pickwick's syndrome).

2. Excess of inhibitory afferent influences on the respiratory center (for example, with strong pain accompanying the act of breathing, which is noted with pleurisy, chest injuries).

3. Direct damage to the respiratory center due to brain damage - traumatic, metabolic, circulatory (cerebral atherosclerosis, vasculitis), toxic, neuroinfectious, inflammatory; for tumors and cerebral edema; overdose narcotic substances, sedatives and etc.

4. Disintegration of automatic and voluntary regulation of breathing (during the formation of powerful flows of afferent impulses: pain, psychogenic, chemoreceptor, baroreceptor, etc.

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32.3.1. Obstructive pulmonary ventilation disorders

Restrictive breathing disorders

At the core restrictive(from lat.

restrictio– limitation) of pulmonary ventilation disorders lies in the limitation of their expansion in the inhalation phase as a result of intrapulmonary and extrapulmonary causes. It is based on changes in the viscoelastic properties of lung tissue.

Intrapulmonary causes of restrictive type of alveolar hypoventilation cause a decrease in respiratory surface area and/or a decrease in lung compliance. Such causes are: pneumonia, benign and malignant tumors, tuberculosis, lung resection, atelectasis, alveolitis, pneumosclerosis, pulmonary edema (alveolar or interstitial), impaired surfactant formation in the lungs, damage to the elastin of the pulmonary interstitium (for example, due to exposure to tobacco smoke). With a decrease in the formation or destruction of surfactant, the ability of the lungs to stretch during inspiration decreases, which is accompanied by an increase in the elastic resistance of the lungs. As a result, the depth of inspiration decreases and the respiratory rate increases. Shallow, rapid breathing occurs (tachypnea).

Compliance (compliance) of the lungs(∆V/∆P) is a value characterizing the change in lung volume per unit of transpulmonary pressure; it is the main factor determining the limit of maximum inspiration. Extensibility is a value inversely proportional to elasticity. Hypoventilation disorders of the restrictive type are characterized by a decrease in static volumes (VC, FRC, TLC) and a decrease in the driving force of the expiratory flow. The function of the airways remains normal, therefore, the air flow speed does not change. Although FVC and FEV1 are decreased, the FEV1/FVC% ratio is normal or elevated. In restrictive pulmonary disorders, lung compliance (∆V/∆P) and elastic recoil of the lungs are reduced. Therefore, the volumetric rate of forced expiration SOS25-75 (averaged value over a certain period of measurements from 25% to 75% FVC) decreases even in the absence of airway obstruction. FEV1, which characterizes the volumetric expiratory flow rate, and the maximum expiratory flow rate in restrictive disorders is reduced due to a decrease in all pulmonary volumes (VC, FUEL, TLC).

Hypoventilation breathing disorders often occur due to dysfunction of the respiratory center and breathing regulation mechanisms. Due to disruption of the respiratory center, they are accompanied by severe disturbances in rhythmogenesis, the formation of pathological types of breathing, and the development of apnea.

There are several forms of disruption of the respiratory center depending on the disorder of afferentation.

1. Deficiency of excitatory afferent influences on the respiratory center (with immaturity of chemoreceptors in premature newborns; with poisoning with narcotic drugs or ethanol, with Pickwick's syndrome).

2. Excess of inhibitory afferent influences on the respiratory center (for example, with severe pain accompanying the act of breathing, which is noted with pleurisy, chest injuries).

4. Disintegration of automatic and voluntary regulation of breathing (during the formation of powerful flows of afferent impulses: pain, psychogenic, chemoreceptor, baroreceptor, etc.

The following types of ventilation disorders are distinguished: obstructive, restrictive, mixed.
Obstructive ventilation disorders
Several mechanisms underlie these disorders:
increased tone of bronchial smooth muscles (bronchospasm);
swelling of the bronchial mucosa (inflammatory, allergic, congestive);
hypersecretion of mucus by tracheobronchial glands. Hypercrinia (increased secretion volume) in combination with discrinia (increased viscosity and adhesiveness of secretion) is important.
The predominance of this component allows us to speak about the broncho-obstructive variant of broncho-obstructive syndrome;
cicatricial deformation of the bronchi as a result chronic inflammation respiratory tract (in this case, the narrowing of the lumen of the bronchi alternates with its expansion, increasing the aerodynamic
resistance, i.e. resistance to air flow);
dyskinetic mechanism of broncho-obstructive syndrome - expiratory collapse (inferiority of the membranous part of the respiratory tract, blocking the lumen of the bronchi on
exhale);
early expiratory closure of small airways in emphysema (valvular obstruction mechanism).

Broncho-obstructive syndrome

Clinically, broncho-obstructive syndrome can manifest itself in several variants: 1) an attack of suffocation with the appearance of expiratory dyspnea, forced position (orthopnea),
“wheezing” breathing. Observed in bronchial asthma; 2) difficult, usually shallow breathing with prolonged exhalation without clearly defined attacks of suffocation. Observed
more often in chronic obstructive pulmonary disease, emphysema
lungs.
Physical signs of broncho-obstructive syndrome:
percussion tone with a boxy tint, harsh breathing with prolonged exhalation, whistling dry rales over the entire surface of the lungs, distant wheezing.

Changes in spirogram in broncho-obstructive syndrome

1. Slowdown of FVC due to increased resistance provided respiratory tract air flow.
2. Decrease in FEV
3. Decrease in FEV^VC.
4. Decrease in average volumetric velocities (SOS25.75) at the Level of 25-75% FVC.
5. Reduction of maximum volumetric velocities (MOF25, MOS50, MOS75) at the level of 25-75% FVC.
6. Decrease in PSV (peak volumetric flow rate) at the level of 5~10% FVC. A decrease in POS, closely correlating with a decrease in FBR
7- Reduced MVL.

Restrictive ventilation disorders

The basis of restrictive (from the Latin restrictio - restriction) violations of lung ventilation is the limitation of their expansion
as a result of intrapulmonary and extrapulmonary causes.
Intrapulmonary causes: 1) extensive pneumonia; 2) atelectasis; 3) tuberculous infiltrates; 4) fibrosing alveoli
itis (with the outcome in the so-called cellular lung); 5) pulmonary edema of various origins; 6) lung tumors.
Extrapulmonary causes: 1) compression of the lungs by liquid or air in the pleural cavity (hydrothorax, pneumothorax) with the development
compression atelectasis; 2) the presence of massive pleural adhesions compressing the lung (fibrothorax); 3) changes
chest in the form of its deformation or stiffness (kyphoscoliosis, ankylosing spondylitis), as well as respiratory pathology
muscles; 4) changes in organs abdominal cavity, leading to a limitation of the respiratory excursion of the lungs (increased
liver, flatulence, ascites, obesity, etc.).
The main manifestation of restrictive disorders is respiratory failure caused by restriction of the alveolar
surface and deterioration of blood oxygenation. Basic clinical sign- shortness of breath of inspiratory or mixed type;
physical signs depend on the reasons that caused the restriction.

Signs of restrictive disorders on a spirogram

1. Decrease in vital capacity.
2. FEV[ is normal.
3. Increase in FEV1/VC.
4. Speed indicators SOS25.75, MOS25.75, POS are within normal limits.

The breathing process is a very important component for any living organism on our planet. Breathing problems may cause various diseases associated primarily with oxygen starvation. Very developed respiratory system, despite its maturity and much structure, is subject to various interruptions and disturbances. Due to the complex structure of the human body, there may be several reasons for this, ranging from problems with the airways.

Experts distinguish the following types of breathing disorders:

obstructive;
restrictive;
mixed.

These types differ primarily in the underlying causes that caused the violation of the biomechanics of breathing. With obstruction, the patency of the airways that carry oxygen to human organs is significantly reduced.

There is such an ailment as obstructive syndrome, which is characterized precisely by the fact that during sleep a person may experience numerous pauses in breathing, while the sleeper cannot control this. Doctors call most of its main causes excess weight(accumulation of fat) and anatomical features structure of the nose and throat.

Restrictive breathing disorders are disorders associated with limited expansion of the lungs. Due to pulmonary interruptions, more energy is used in other organs responsible for breathing, and accordingly, the load on them increases several times. Ventilation of the lungs and gas exchange in them become difficult. These signs also lead to oxygen starvation at the stages of complications.

Treatment

Treatment for these breathing disorders is usually aimed not at relieving symptoms, but at restoring normal ventilation. For these purposes, oxygen therapy is carried out - the supply of oxygen to the human body in certain quantities and concentrations. Chest massage, swimming, water aerobics, physiotherapy, regular walks in the fresh air.

Video

Obstructive ventilation disorders occur due to: 1. narrowing of the lumen of small bronchi, especially bronchioles due to spasm ( bronchial asthma; asthmatic bronchitis); 2. narrowing of the lumen due to thickening of the walls of the bronchi (inflammatory, allergic, bacterial edema, edema due to hyperemia, heart failure); 3. the presence of viscous mucus on the cover of the bronchi with an increase in its secretion by goblet cells of the bronchial epithelium, or mucopurulent sputum 4. narrowing due to cicatricial deformation of the bronchial tube; 5. development of endobronchial tumor (malignant, benign); 6. compression of the bronchi from the outside; 7. presence of bronchiolitis.

Restrictive ventilation disorders have the following causes:

1. pulmonary fibrosis (interstitial fibrosis, scleroderma, berylliosis, pneumoconiosis, etc.);

2. large pleural and pleurodiaphragmatic adhesions;

3. exudative pleurisy, hydrothorax;

4. pneumothorax;

5. extensive inflammation of the alveoli;

6. large tumors of the lung parenchyma;

7. surgical removal parts of the lung.

Clinical and functional signs of obstruction:

1. Early complaint of shortness of breath during previously acceptable exercise or during a “cold.”

2. Cough, often with scanty sputum, which for some time causes a feeling of heavy breathing (instead of easier breathing after a normal cough with sputum).

3. The percussion sound is not changed or initially acquires a tympanic tone over the posterolateral parts of the lungs (increased airiness of the lungs).

4. Auscultation: dry wheezing. The latter, according to B. E. Votchal, should be actively detected during forced exhalation. Auscultation of wheezing during forced expiration is valuable in terms of judging the spread of bronchial obstruction throughout pulmonary fields. Breathing sounds change in the following sequence: vesicular breathing - hard vesicular - hard, indefinite (drowns out wheezing) - weakened hard breathing.

5. More late signs are prolongation of the expiratory phase, participation of auxiliary muscles in breathing; retraction of the intercostal spaces, drooping of the lower border of the lungs, limited mobility of the lower edge of the lungs, the appearance of a box-like percussion sound and expansion of its distribution zone.

6. Decrease in forced pulmonary tests (Tiffno index and maximum ventilation).

In the treatment of obstructive insufficiency, the leading place is occupied by bronchodilator drugs.

Clinical and functional signs of restriction.

1. Shortness of breath on exertion.

2. Rapid, shallow breathing (short - quick inhalation and quick exhalation, called the “slamming door” phenomenon).

3. Chest excursion is limited.

4. Percussion sound is shortened with a tympanic tint.

5. The lower border of the lungs is higher than usual.

6. The mobility of the lower edge of the lungs is limited.

7. Weakened vesicular breathing, crackling or moist wheezing.

8. Decrease in vital capacity (VC), total lung capacity (TLC), decrease in tidal volume (TI) and effective alveolar ventilation.

9. There are often disturbances in the uniform distribution of ventilation-perfusion ratios in the lungs and diffuse disturbances.

Separate spirography Separate spirography or bronchospirography allows you to determine the function of each lung, and therefore the reserve and compensatory capabilities of each of them.

Using a double-lumen tube inserted into the trachea and bronchi, and equipped with inflatable cuffs to obstruct the lumen between the tube and the bronchial mucosa, it is possible to obtain air from each lung and record the breathing curves of the right and left lungs separately using a spirograph.

Separate spirography is indicated to determine functional indicators in patients subject to surgical interventions on the lungs.

There is no doubt that a clearer picture of impaired bronchial obstruction is provided by recording air flow velocity curves during forced exhalation (peak fluorimetry).

Pneumotachometry- is a method for determining the speed and power of an air stream during forced inhalation and exhalation using a pneumotachometer. After resting, the subject, sitting, exhales deeply into the tube as quickly as possible (the nose is turned off using a nose clip). This method, is mainly used to select and evaluate the effectiveness of bronchodilators.

Average values for men - 4.0-7.0 l/l for women - 3.0-5.0 l/s During tests with the administration of bronchospasmolytics, it is possible to differentiate bronchospasm from organic lesions of the bronchi. Expiratory power decreases not only with bronchospasm, but also, although to a lesser extent, in patients with weakness of the respiratory muscles and severe chest rigidity.

General plethysmography (GPG) is a method of directly measuring the value of bronchial resistance R during quiet breathing. The method is based on synchronous measurement of air flow velocity (pneumotachogram) and pressure fluctuations in a sealed cabin where the patient is placed. The pressure in the cabin changes synchronously with fluctuations in alveolar pressure, which is judged by the proportionality coefficient between the volume of the cabin and the volume of gas in the lungs. Plethysmography better reveals small degrees of narrowing of the bronchial tree.

Oxygenometry- this is a blood-based determination of the degree of oxygen saturation arterial blood. These oximeter readings can be recorded on moving paper in the form of a curve - an oxihemogram. The operation of the oximeter is based on the principle of photometric determination of the spectral features of hemoglobin. Most oximeters and oxygemographs do not determine the absolute value of arterial blood oxygen saturation, but only make it possible to monitor changes in blood oxygen saturation. For practical purposes, oximetry is used to functional diagnostics and assessing the effectiveness of treatment. For diagnostic purposes, oximetry is used to assess the state of external respiration and circulatory function. Thus, the degree of hypoxemia is determined using various functional tests. These include - switching the patient's breathing from air to breathing pure oxygen and, conversely, a test with holding the breath while inhaling and exhaling, a test with dosed physical activity, etc.

In order for a person’s lungs to function normally, several important conditions must be met. Firstly, the possibility of free passage of air through the bronchi to the smallest alveoli. Secondly, a sufficient number of alveoli that can support gas exchange and thirdly, the possibility of increasing the volume of the alveoli during the act of breathing.

According to the classification, it is customary to distinguish several types of pulmonary ventilation disorders:

Restrictive
Obstructive
Mixed

The restrictive type is associated with a decrease in the volume of lung tissue, which occurs in the following diseases: pleurisy, pulmonary fibrosis, atelectasis and others. Extrapulmonary causes of ventilation impairment are also possible.

The obstructive type is associated with impaired air conduction through the bronchi, which can occur with bronchospasm or other structural damage to the bronchus.

The mixed type is distinguished when violations of the two above types are combined.

Methods for diagnosing pulmonary ventilation disorders

To diagnose pulmonary ventilation disorders of one type or another, a number of studies are carried out to assess the indicators (volume and capacity) that characterize pulmonary ventilation. Before we look in more detail at some of the studies, let's look at these basic parameters.

Tidal volume (VT) is the amount of air that enters the lungs in 1 breath during quiet breathing.
Inspiratory reserve volume (IRV) is the volume of air that can be maximally inhaled after a quiet inhalation.
Expiratory reserve volume (ERV) is the amount of air that can be additionally exhaled after a quiet exhalation.
Inspiratory capacity – determines the ability of the lung tissue to stretch (sum of DO and ROvd)
Vital capacity of the lungs (VC) - the volume of air that can be maximally inhaled after a deep exhalation (the sum of DO, ROvd and ROvyd).

As well as a number of other indicators, volumes and capacities, on the basis of which the doctor can draw a conclusion about a violation of pulmonary ventilation.

Spirometry

Spirometry is a type of study that is based on performing a series of breathing tests with the participation of the patient in order to assess the degree of various pulmonary disorders.

Goals and objectives of spirometry:

assessment of severity and diagnosis of lung tissue pathology
assessment of disease dynamics
assessment of the effectiveness of the disease therapy used

Progress of the procedure

During the study, the patient, in a sitting position, inhales and exhales air with maximum force into a special apparatus, in addition, inhalation and exhalation parameters during quiet breathing are recorded.

All these parameters are recorded using computer devices on a special spirogram, which is deciphered by the doctor.

Based on the spirogram indicators, it is possible to determine what type - obstructive or restrictive - a violation of pulmonary ventilation has occurred.

Pneumotachography

Pneumotachography is a research method in which the speed and volume of air during inhalation and exhalation are recorded.

Recording and interpreting these parameters makes it possible to identify diseases that are accompanied by impaired bronchial patency in early stages, for example bronchial asthma, bronchiectasis and others.

Progress of the procedure

The patient sits in front of a special device to which he is connected using a mouthpiece, as in spirometry. Then the patient takes several consecutive deep breaths and exhalations, and so on several times. Sensors record these parameters and construct a special curve, on the basis of which the patient is diagnosed with conduction disorders in the bronchi. Modern pneumotachographs are also equipped with various devices that can be used to record additional indicators of respiratory function.

Peak flowmetry

Peak flowmetry is a method that determines how fast a patient can exhale. This method is used to assess how narrowed the airways are.

Progress of the procedure

The patient, in a sitting position, performs a calm inhalation and exhalation, after which he inhales deeply and exhales as much air as possible into the mouthpiece of the peak flow meter. A few minutes later he repeats this procedure. Then the maximum of the two values is recorded.

CT scan of the lungs and mediastinum

Computed tomography of the lungs - method x-ray examination, which allows you to obtain layer-by-layer image slices and, on their basis, create a three-dimensional image of the organ.

Using this technique, you can diagnose such pathological conditions as:

chronic pulmonary embolism
occupational lung diseases associated with inhalation of particles of coal, silicon, asbestos and others
identify tumor lesions of the lungs, condition lymph nodes and the presence of metastases
identify inflammatory lung diseases (pneumonia)
and many other pathological conditions

Bronchophonography

Bronchophonography is a method that is based on the analysis of respiratory sounds recorded during the respiratory act.

When the lumen of the bronchi or the elasticity of their walls changes, then bronchial conductivity is disrupted and turbulent air movement is created. As a result, various noises are formed that can be recorded using special equipment. This method is often used in pediatric practice.

In addition to all of the above methods for diagnosing pulmonary ventilation disorders and the causes that caused these disorders, bronchodilation and bronchoprovocation tests are also used with various drugs, study of the composition of gases in the blood, fibrobronchoscopy, lung scintigraphy and other studies.

Treatment

Treatment of such pathological conditions solves several main problems:

Restoration and support of vital ventilation and blood oxygenation
Treatment of the disease that caused the development of ventilation impairment (pneumonia, foreign body, bronchial asthma and others)

If the cause was a foreign body or blockage of the bronchial tube with mucus, then these pathological conditions It can be easily eliminated using fiberoptic bronchoscopy.

However, the more common causes of this pathology are chronic diseases lung tissue, for example chronic obstructive pulmonary disease, bronchial asthma and others.

Such diseases are treated over a long period of time using complex drug therapy.

At pronounced signs Oxygen starvation is carried out with oxygen inhalation. If the patient breathes on his own, then with the help of a mask or nasal catheter. During a coma, intubation and artificial ventilation are performed.

In addition, various measures are taken to improve the drainage function of the bronchi, for example, antibiotic therapy, massage, physiotherapy, physical therapy in the absence of contraindications.

A serious complication of many disorders is the development of respiratory failure of varying severity, which can lead to death.

In order to prevent the development of respiratory failure due to pulmonary ventilation disorders, it is necessary to try to diagnose and eliminate possible risk factors in time, as well as to keep under control the manifestations of existing chronic lung pathology. Only timely consultation with a specialist and well-chosen treatment will help avoid negative consequences in future.