肺結核症の心肺機能に関する研究 (第2報) : 肺結核症の心肺機能に及ぼす純酸素吸入の影響に関する研究

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The effect of pure oxygen breathing on the pulmonary circulation has been reported in animal by Von Euler and Liljestrand, O. Nisell, Straud and Rahn, and in human by Dressler et al, who concluded that the failling of the pulmonary arterial pressure, observed in this condition, was induced by dilatation of the pulmonary vasculature and was not resulted from a decrease in the cardiac output. The author studied on the effects of the pure oxygen breathing on the pulmonary circulation in patients with pulmonary tuberculosis. The mechanism of the falling of the pulmonary arterial pressure is discussed in this article.Materials and Method : Seven patients with pulmonary tuberculosis studied are consisted of three minimal, two moderately advanced and two far advanced cases, on the bases of the classification of the American Tuberculosis Association.The same methods and apparatus as described in the former chapter were used. The arterial oxygen saturation in pure oxygen breathing was calculated with a refererence to the results of Fasciolo and Chiodi, and all values over 100 percent were described as 100 percent.Results : In all cases, the pulmonary arterial pressure was fallen by the pure oxygen breathing and the fall was more marked in the systolic pressure than in the diastolic. Respiratory fluctation of the pulmonary arterial pressure became more marked when the patients were in the pure oxygen breathing.In few cases, reduction of the pulse pressure of the pulmonary artery in the oxygen breathing was found, and in the other cases except for two of far advanced cases, fall of the pulmonary arterial pressure continued for a considerably long period, in maximum around 20 minutes after cessation of the pure oxygen breathing.In four cases, wedge pressures were the same or slightly high in the pure oxygen breathing than those in the normal breathing.In four cases out of six oxygen saturation of the arterial blood reached 100 percent, but in the remaining two far advanced cases it did not reach 100 percent in the pure oxygen breathing.The pulse rates in the pure oxygen breathing were different in the cases examined, without a definite tendency.The shape of the pulmonary arterial pressure curve in the pure oxygen breathing showed the expansion of the elastic elevation, in contrast to the shape in hypoxia. Discussion and Summary : Six patients with pulmonary tuberculosis were studied by the right heart catheterization technique on the pulmonary arterial pressure in the oxygen breathing. Lowering of the pulmonary arterial pressure was observed, continuing for a considerably long time after the cessation.The following causes could be considered for the fall of the pulmonary arterial pressure in the pure oxygen breathing, as described previously by Dressler et al ; 1) decrease of the cardiac output, 2) fall of the pulmonary venous or left atrial pressure, and 3) dilatation of the pulmonary vasculature.It was impossible to known whether the cardiac output was decreased or not in the pure oxygen breathing ; because lack of the definite changes in the pulse pressure and pulse rate was remarkable in a series of studies presented here, both of which were postulated as good marks indicating changes in the cardiac output.Judging from the results obtained in the hypoxia study, it is of doubt that changes in the cardiac output are responsible for the falling of the pulmonary arterial pressure in pure oxygen breathing. In the pure oxygen breathing, the falling of the pulmonary venous or left atriel pressure is not thought to be occurred, because of being observed no changes or the elevation in the wedge pressure, which probably indicates the former two pressures.Therefore, the falling of the pulmonary arterial pressure, occurred in the pure oxygen breathing, should be caused by dilatation of the pulmonary vasculature.The changes in the shape of the pulmonary arterial pressure curve illustrated in Fig. 18 seem to show directly the dilatation of the peri
社団法人日本循環器学会の論文
1960-10-20

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加藤正之
国立療養所貝塚千石荘

肺結核症の心肺機能に関する研究 (第2報) : 肺結核症の心肺機能に及ぼす純酸素吸入の影響に関する研究

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