Abstract：
:This article reviews the basic pathophysiologic mechanisms underlying the abnormal pulmonary gas exchange often seen in patients with cirrhosis. To summarize, the following keypoints seem appropriate: (1) Patients with cirrhosis have a low pulmonary vascular tone characterized by a poor or absent hypoxic pressor response. This results in a marked dilation of the pulmonary vasculature. (2) This abnormal pulmonary vascular tone, independently of airway disease, causes VA/Q mismatch and mild to moderate hypoxemia. Yet, as liver disease progresses and hepatocellular function deteriorates, more severe degrees of intrapulmonary shunt emerge and, probably, O2 diffusion limitation ensues, causing severe respiratory failure (see Table 1). (3) At rest, the high cardiac output and minute ventilation of cirrhosis minimize the degree of arterial hypoxemia that otherwise would be expected from the observed degree of both VA/Q inequality and intrapulmonary shunt. During exercise, the relative "normalization' (with respect to metabolic demands) of the hemodynamic and ventilatory status of the patient explains the fall in PaO2. (4) A clear pathogenic mechanism of these pathophysiologic abnormalities is still lacking, although available evidence suggests that both the liver and the endothelial cells may play a pivotal role in the regulation of the pulmonary vascular tone in these patients. (5) To date, no pharmacologic intervention has been effective in treating hypoxemia in these patients. Yet liver transplantation helps in most of them. This observation reinforces the functional nature of the gas exchange abnormalities of cirrhosis.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Agusti AG,Roca J,Rodriguez-Roisin Rdoi
10.1016/s0272-5231(05)70298-7subject
Has Abstractpub_date
1996-03-01 00:00:00pages
49-66issue
1eissn
0272-5231issn
1557-8216pii
S0272-5231(05)70298-7journal_volume
17pub_type
杂志文章,评审abstract：:Millions of people worldwide engage in leisure or occupational activities in extreme environments. These environments entail health risks even for normal subjects. The presence of lung disease, or other conditions, further predisposes to illness or injury. Patients who have lung conditions should, but often do not, co...
journal_title：Clinics in chest medicine
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abstract：:Continuous mechanical ventilation used for life support is accepted as standard practice in nearly every hospital in the United States today. The history of the evolution of techniques that we take virtually for granted today is fascinating. This article recounts some of the highlights in the development of modern-day...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-03-01 00:00:00
abstract：:The spectrum of HIV-associated pulmonary diseases is broad. Opportunistic infections, neoplasms, and noninfectious complications are all major considerations. Clinicians caring for persons infected with HIV must have a systematic approach. The approach begins with a thorough history and physical examination and often ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1991-06-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1984-06-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1986-12-01 00:00:00
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-09-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1995-12-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70257-4
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1991-09-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1995-06-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1992-09-01 00:00:00
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
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journal_title：Clinics in chest medicine
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70061-7
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journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1994-12-01 00:00:00
abstract：:This article assesses the role of pharmacotherapy in the management of respiratory muscle dysfunction. It focuses on two classes of drugs, the methylxanthines and the sympathomimetic agents. A prospective section focuses also on the particularities of the diaphragm among the skeletal striated muscles. In addition, a n...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-06-01 00:00:00
abstract：:Smoking is overwhelmingly the major cause of chronic bronchitis and emphysema worldwide. Additional risk factors for developing COPD are presented, along with the variables that govern cigarette smoke deposition in the lung. Major paradigms for the pathogenesis of COPD, including the protease-antiprotease and oxidant-...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70008-3
更新日期：2000-03-01 00:00:00
