Two functional levels of mechanical energy intrapulmonary source have been viewed in this article for the first time. The first level is located into the perialveolar space. This level provides inspiratory and expiratory activity of the lungs together with respiratory muscles. Due to this, the inspiratory alveolar pressure is lower than the intrapleural pressure and the expiratory alveolar pressure is higher than the intrapleural pressure. This is deter mined by work of breathing measured as negative elastic hysteresis area and allows overcoming some nonelastic resistance of the lungs. The lung activity on overcoming the elastic resistance is estimated by multiplying the total work of breathing by a functional coefficient of lung elasticity (FCLE). The latter is calculated by dividing the total lung compliance by the dynamic lung compliance and reflects change in the elastic lung tension from spontaneous breathing level to the total lung compliance level. FCLE approximates 1 in healthy subjects and in patients with normal lung elastic recoil (LER). LER is lower and the total lung capacity is higher in lung obstructive diseases. Consequently, the total lung compliance could increase and FCLE could grow up to 10 in such cases (for instance, in severe emphysema). This leads to increasing lung activity on overcoming the elastic resistance up to 10 kgf × m / min or higher. Actually, this huge work of breathing is not performed due to the 2nd level of lung mechanical activity that is an active dilation of the large airways on expiration; this mechanism prevents valvular bronchial obstruction.

Цель – изучить диагностические возможности пульмоносцинтиграфии в оценке нарушений легочной микроциркуляции и вентиляции при инфильтративном туберкулезе легких (ИТЛ), протекающем на фоне хронической обструктивной болезни легких (ХОБЛ), в сравнении с ХОБЛ. 30 пациентам обоего пола с верифицированными диагнозами ИТЛ на фоне ХОБЛ I–II стадии (n = 10) и ХОБЛ I–II стадии (n = 20) была проведена вентиляционно-перфузионная пульмоносцинтиграфия. Результаты: при ИТЛ на фоне ХОБЛ было обнаружено уменьшение апикально-базального градиента перфузии в обоих легких (р = 0,02 и 0,001), а также двустороннее повышение альвеолярно-капиллярной проницаемости (АКП) с первых минут исследования по сравнению с аналогичными показателями у больных ХОБЛ. Так, АКП в пораженном и интактном легких на 10-й мин исследования составила 47,05 (35,05–52,01) % и 33,35 (31,95–44,75) %, на 30-й мин – 52,65 (50,25–55,30) % и 50,01 (48,70–56,45) % соответственно (р = 0,00005 и 0,0004, 0,00006 и 0,00005). Таким образом, выявленные изменения показателей вентиляционно-перфузионной пульмоносцинтиграфии могут быть использованы в качестве дополнительных критериев в диагностике ИТЛ на фоне ХОБЛ.

The integral and regional values tissues of non-elastic resistance lungs (NERLi, NERLr) in 17 patients with bronchial asthma (BA), 25 – chronic obstructive pulmonary disease (COPD) and 30 healthy volunteers are investigated by means of simultaneous recording of zonal reogrammes of ventilation and transpulmonal pressure.The increase of NERLi in patients with BA is accompanied by the increase of the NERLr values inhaling in the lower zones, and exhale in the middle and lower areas of both lungs. Significant increase of NERLi In COPD accompanied by the increase of the NERLr values on the exhalation in the middle and lower areas of the right lung. And values of NERLr in BA almost 2.5 times higher than the similar values in patients with COPD. Apparently, in BA is due to an increase in the permeability of the alveolar-capillary membrane in connection with an immune inflammation, and in COPD – effect of other factors, among which the actual tissue friction and reducing of mechanical activity light to overcome the total resistance.

Summary. Regional ventilation-perfusion ratio (V / Q), alveolar-capillary permeability (ACP) and pulmonary tissue non-elastic resistance (PTNER) were studied in 25 patients with moderate persistent bronchial asthma (BA) with length of the disease of 1.5–2 years after first manifestation and in 55 healthy volunteers. In patients with normal bronchial resistance (Raw) the regional PTNER was increased in lower areas of the lungs; in patients with increased Raw PTNER was increased in lower and middle areas which was accompanied by similar increase in V / Q in the middle and lower areas of the lungs. Total increase in ACP was registered independently on the level of Raw and regional TNPR; this fact suggests the disorders in the alveolar department of the lungs and could improve diagnosis of early-stage BA.

We examined 25 patients with Stage I—II COPD to study diagnostic capabilities of ventilation-perfusion pulmoscintigraphy in relation to the assessment of lung microcirculation and ventilation disorders. Scintigraphic studies were performed by means of the Omega 500 gamma camera (Technicare, USA— Germany). COPD is characterized with the bilateral increase in the apical-basal grade of perfusion and deceleration of the alveolar-capillary permeability. The detected changes of scintigraphic parameters can be used in COPD diagnostics.

Summary. Ventilation scintigraphy of the lungs with analysis of alveolar-capillary permeability (ACP) was performed in patients with confirmed diagnoses of community-acquired pneumonia (CAP, n = 40), infiltrative pulmonary tuberculosis (IPT, n = 20), distal pulmonary embolism (DPE, n = 11),peripheral lung carcinoma (PLC, n = 17), and in 22 healthy volunteers. ACP values were higher in affected and intact lungs in patients with CAP at 10 and 30 min of the investigation vs those with DPE and were higher at 30 min in the affected lung in patients with CAP compared to patients with IPT. Comparison of ACPs in DPE and IPT patients revealed the ACP reduction in affected and intact lungs of DPE patients at 30 min of the investigation. PLC patients demonstrated the ACP reduction in affected lung compared to contralateral lung. Therefore, ACP gave additional information for differential diagnosis of CAP, IPT, DPE and PLC

Aim: to study and characterize regional changes of non-elastic pulmonary resistance (NPR) and compare these data with regional values of alveolar#capillary permeability (ACP) in patients with community-acquired pneumonia (CAP). 29 CAP patients underwent evaluation of the regional NPR values (in the superior, central and inferior lung lobes) by means of simultaneous recording of zonal ventilation rheograms and transpulmonary pressure as well as ACP by the method of ventilation pulmoscintigraphy. Also the Masterlab Pro body plethysmography system (manufactured by the Erich Jaeger Company, Germany) was used to measure bronchial resistance. The integral total non-elastic pulmonary resistance (TNPR) increases in case of CAP; at the same time, the regional TNPR changes are non-uniform. Both the integral ACP values in the affected and intact lungs and the regional ACP values in the affected and intact lung lobes were significantly increased in case of CAP, which testifies to generalized affection of the structures of the alveolar-capillary membrane of the lungs. Taking into account the detected generalized increase of ACP, it seems that the mechanism of the TNPR increase consists in the change of inspiratory-expiratory blood filling of the lungs as well as respiratory fluctuations of the degree of intensity of the alveolar and interstitial inflammatory edema. The achieved results of the changes in the regional TNPR and ACP values testify to the increased intrinsic mechanical activity of the lungs in these areas. This increased activity contributes to overcoming a significant part of the total non-elastic pulmonary resistance.

Thirty nine patients having verified community-acquired pneumonia (CAP) and 14 patients having peripheral lung cancer underwent ventilation-perfusion scintigraphic study. Scintigraphic indices of CAP are concluded to be: increased ventilation-perfusion ratio, perfusion and ventilation gradient in the affected side towards to contralateral side and two-sided accelerationof alveolar-capillary permeability for radioactive aerosol. Key words: ventilation-perfusion pulmonal scintigraphy, alveolar-capillary permeability, peripheral pulmonary cancer, extra-hospital pneumonia.

This article includes the results of the study of the infusion epidural analgesia influence on patience's ventilation and perfusion. These patince underwent radical operations on lungs. Research method ventilation-perfusion scintigraphy. The main group consists of patience who receive epidural analgesia in postoperative period and had normal rates of ventilation-perfusion ratio (V/Q) and apicalcore gradient of ventilation and perfusion (U/L). There were evident disorder of ventilation and perfusion in the comparison group. This data shows that prolonged epidural analgesia is very effective as a preventive method of perfusion and ventilation disorders in early postoperative period.

Abnormalities in pulmonary ventilation and perfusion are observed in postoperative period in lung cancer patients due to breathing biomechanics damages caused by pain syndrome. It often results in complications in the form of pulmonary atelectasis and pneumonies. In our study, lung cancer patients underwent infusion thoracic epidural analgesia for postoperative pain control after radical operation on the lungs. To assess the effect of infusion thoracic epidural analgesia on pulmonary ventilation and perfusion processes, ventilation-perfusion scintigraphy was performed. The study results showed, that in early postoperative period, parameters of ventilation-perfusion ratio (V/Q) and apex-base gradient of perfusion (U/L-Q) and ventilation (U/L-V) were in normal limits in lung cancer patients who underwent prolonged thoracic epidural analgesia, whereas perfusion abnormalities took place in the control group patients who did not undergo prolonged thoracic epidural analgesia. Thus, prolonged thoracic epidural analgesia is the effective method for prevention of pulmonary perfusion and ventilation abnormalities in early postoperative period at surgical stage of combined treatment for lung cancer.