肺水腫の診断
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Experimental and clinical studies of pulmonary edema have revealed a fact that the early diagnosis of pulmonary edema could be made with reasonable accuracy and within shorter time with the corroborative use of the chest roentgenogram and radiocardiogram.The experimental method used was by inducing a pulmonary edema by the injection of epinephrin in rabbits. Fifty rabbits were examined by means of chest roentgenogram and radiocardiogram at definite intervals as well as roentgenograms of excised lungs were taken following death or sacrifice of the animals.For clinical investigation thirty one selected cardiac cases and four post-operative cases in which occurrence of pulmonary edema was suspected were similarly followed up by the use of radiological and radiocardiographic methods.The following summarized results were obtained : 1. In the experimantal pulmonary edema, the early picture of diagnostic value was characterized by irregular and uneven pulmonary vascular margin and speckled shadow of the vessels.2. The radiocardiogram showed marked prolongation and flatness which prevented a close study of circulation time, hence, a method of estimating the Returning Ratio of Venous Blood Flow (=Returning Ratio) was devised, that is-Returning Ratio of Venous Blood Flow=(Injection to HB time)/(HB to HS time)×100%, and an estimation was made of each case. By this method, it was possible to demonstrate theoretically as well as experimentally that the reduction of the Returning Ratio signified left heart failure, and that its increase signified the right heart failure; and the Ratio necessary for pulmonary edema was found to be less than 8.2 percent.3. The radiocardiographic findings of the average value of fourteen healthy adults were as follows : Returning time to right heart is 3.0 seconds, Mean pulmonary circulation time is 4.6 sec., Executed time by left ventricle is 9.6 sec., Heart phase is 16.4 sec. and Returning Ratio of Venous Blood Flow is 18.3 percent.4. The clinical signs and symptoms and the radiocardiograms, particularly its Returning Ratio were compared of thirty one cases of heart diseases. Seven cases which presented the symptoms of pulmonary congestion showed marked extension of radiocardiogram, having the Returning Ratio somewhere between 3.3 percent to 11.1 percent ; signs of pulmonary congestion was never observable in those cases in which the Returning Ratio was above 13.8 percent.5. Among the seven cases with symptoms of pulmonary congestion, three were clinically suspected of pulmonary edema ; however, none of them gave roentgenological evidence of the pulmonary edema, and these cases were diagnosed as cases of preedematic condition.6. Two cases showed signs of pulmonary edema, and the radiocardiograms were definitely prolonged similar to those of congested lungs, and the Returning Ratio were 10.6 percent and 8.1 percent. There were evidences of specks and irregular vascular margins of the pulmonary vessel shadow in either case.7. The radiocardiographic studies of four post-operative cases, namely, one case of the gastric resection, and three cases of pulmonary lobectomy in which the pulmonary edema was suspected revealed that the Returning Ratio was well over 12.3 percent ; so the occurrence of pulmonary edema was denied.8. The foregoing results seem to demonstrate that the radiocardiogram of prolongation or marked flatness type with Returning Ratio below 11.1 percent signifies a dangerous state, i.e., the onset of pulmonary edema, and then, by closer observation with use of roentgenogram to seek the characteristic pictures of pulmonary vessels, pulmonary edema can be diagnosed in early stage.
- 社団法人日本循環器学会の論文
- 1960-07-20