各種虚脱療法並びに肺切除術の肺結核患者の心肺機能に及ぼす影響に関する研究(第2報) : 人工気腹術について

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It is said that pnemoperitoneum can be used for the treatment of far advanced pulmonary tuberculosis due to the following reasons. First, pneumoperitoneum does not cause intrapleural complications, and its collapse effect is reversible. Second, its effects upon pulmonary function is relatively slight. A number of authors have found that the impairment of pulmonary function on account of pneumoperitoneum was generally insignificant. There are, however, some reports of the cases of severe pulmonary insufficiency. Therefore the indication for a pneumoperitoneum seems to be self limiting from the point of view of pulmonary function, and pneumoperitoneum can not always be safe in the cases of serious pulmonary insufficiency. But the studies on this point are still unsatisfactory.On the other hand there are a few reports about the effects of pneumoperitoneum on the pulmonary circulation, but the investigations have scarcely been performed of the pulmonary circulation in relation to the effects of pneumoperitoneum upon intrathoracic pressure. This paper reports the present author's results upon these points.Methods : The methods used for venous catheterisation etc. were similar to those described in the first report. The volume air refill during cardiac catheterization was 238-180 cc/kg for therapeutic use. The degree of lung collapse was estimated by dorso-ventral X ray film. It was estimated slight when the area becreased by the rising diaphragm was within one-third of one lung, moderate when the area decreased was from one-third to two-thirds of one lung, and high when it became over two-thirds of one lung. The subjects were 8 patients under pneumoperitoneum (Group I), and 2 patients under both pneumoperitoneum and other types of collapse therapies (Group II.).Results : 1) Group I : The decrease in VC and MBC was moderate (Table II). Minute ventilation tended to increase, but alveolar ventilation ratio was generally on the decrease. After the air refill the former increased, while the latter remained unchanged. Arterial O_2 saturation was nealy normal, but A-a O_2 tension gradient was increased, showing negative correlation with arterial O_2 tension (Fig 1). It was noticed that, after the air refill arterial O_2 saturation dropped in such cases where it was normal before the air refill, while on the other hand it rose where it was low before. Cardiac index tended to decrease, but it was increased after the air refill. Right auricular pressure tended to fall, but pulmonary arterial pressure was clearly elevated. Wedge pressure was normal. After the air refill remarkable changes were found neither in pulmonary arterial pressure nor in wedge pressure. Vascular resistance was found to have clearly increased both in pulmonary arteriolar and pulmonary vascular system. After the air refill, however, the latter remained unchanged while the former decreased. The work of right ventricle against pressure was normal.2) Group II : The decrease in VC was remarkable, and minute ventilation was clearly increased. But arterial O_2 saturation was extremely decreased in one case where measurement was successful, and elevated to its normal value after the air refill. Cardiac index was normal, but decreased distinctly after the air refill. Pulmonary arterial pressure was high, but its further elevation could not be noted after the air refill. Vascular resistance was clearly increased both in pulmonary arteriolar and in pulmonary vascular system, and the former remained unchanged after the air refill.3) The effects of phrenic paralysis upon a patient under pneumoperitoneum : Phrenic paralysis on the left side was performed during cardiac catheterization (Table V). Although minute ventilation was increased after operation, arterial O_2 saturation became remarkably low. Cardiac index increased and pulmonary arterial pressure was clearly elevated after operation, but wedge pressure tended to fall and pulmonary arteriolar resistance increased markedly. The
社団法人日本循環器学会の論文
1960-08-20

各種虚脱療法並びに肺切除術の肺結核患者の心肺機能に及ぼす影響に関する研究(第2報) : 人工気腹術について

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