高血圧症・貧血症などの呼吸・体循環調節に対する急性誘発性低酸素血の影響
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It is clinically worth- while to study the regulatory mechanisms and their limits in reference to systematic circulation and respiration in patients with cardiovascular disease, pulmonary disease and anemiam whose conditions are compensated. Studies with this aim, using the acute anoxia test of Levy (1939) with venous catheterization have been done by Motley (1947) and others. However, the reported studies were done under various different conditions, and the diseases studied, in most cases, were limited to pulmonary tuberculosis, mitral stenosis and congenital heart diseases. Hypertension, anemia and liver diseases have not been studied previously.Professor Hara has been engaged in the pathophisiological study of hypoxemia since his report on the Manchurian myocardial degeneration in 1936. And since 1954 our department undertook the study of visceral circulation (heart, brain, liver and kidney) by the combined use of the induced hypoxia test and venous catheterization.The present paper deals with the influence of oxygen want on the cardio-respiratory hemodynamicsin various diseases, but especially in patients with hypertension and anemia.Materials and Methods : The cases studied totaled 74 (62 males and 12 females) and include 8 healthy controls (Group A), 10 cases of liver diseases (Group B), 8 cases of anemia (Group C), 7 cases of cardiovascular diseases (Group D), 18 cases of hypertension (Group E) and 23 cases of pulmonary tuberculosis (Group F). Cases in groups D and F were those scheduled for surgery, and the examination was done to test the patient's ability to withstand the surgery and also as an aid to diagnosis.The pulmonary and cardiac state of patients was compensated during bed rest and they were considered to be in a steady state before and during the examination. Several cases which complained of severe subjective symptoms or went into shock within a few minutes after beginning the test were excluded. The examinations were done without narcosis and when the patient's stomach was empty. The venous catheter was induced in the usual way. Various values of ventilation, circulation and blood gas were measured before and 20 minutes after 10 percent oxygen breathing.Mean and standard deviation of values and percentage changes obtained before and after hypoxemia were calculated in each group studied. Data were analysed in three ways as shown in Table II and differences between two factors were examined by the "Student's t-distribution " (Tab. I-V).Results Obtained : 1) Considerations on use of the values obtained after 20 minutes low oxygen administration.In the study of cardiac and pulmonary hemodynamics in hypoxemia, Fishman and Yu stressed the importance of a "steady state". However, others administered low oxygen for only 6-13 minutes in many cases, and considerations on this point appear to be lacking. In the present study, oxygen consumption and cardiac output were determined in cases picked at random, twice before and every five minutes during hypoxemia. The results showed that the method used placed subjects in a steady state and that the values after 20 minutes of hypoxemia should be used as the value for hypoxemia.2) Ventilation; especially the inspiratory oxygen supply to the lung.All groups showed approximately normal ventilation values when breathing room air. During administration of low percentage oxygen, all groups responded by increasing the minute ventilation volume by 40-60 percent. This was achieved in groups B and C by increases in ventilation rate ; in group A by an increase of ventilation volume and in group F by increasesin both factors. However the inspiratory oxygen supply (oxygen concentration of inspired air × minute ventilation volume decreased by 23-33 percent. Pulmonary oxygen uptake also decreased. (Figs. 2,3,10,12) 3) Hemodynamics; especially the arterial oxygen availability (oxygen supply to the tissue).During room air respiration, the blood gas and circulation data were about the sam
- 社団法人日本循環器学会の論文
- 1960-01-20