僧帽弁狭窄症に於ける肺循環および呼吸機能に関する臨床的研究 : 特にOxygen Cost of Breathingについて
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It is the purpose of this paper to present the results of the correlative study between hemodynamic and lung function data obtained in the group of patients of mitral valvular disease of rather milder degree. Special references have been made on interrelation between the oxygen cost of breathing estimated as a ratio of increase in oxygen consumption to voluntary increase in ventilation and hemodynamic variations in mitral stenosis cases. Methods : 13 milder cases of mitral stenosis (grade 1 and 2 by New York Heart Association's classification), 2 moderate cases of mitral stenosis (grade 3), 2 cases of mitral regurgitation of grade 2, a case of grade 3 mitral regurgitation, 3 cases of grade 2 mitral stenosis and regurgitation and 12 normal subjects as the control group were studied either by right heart catheterization or by pulmonary function tests. Right heart catheterization was performed by the method originally described by COURNAND. Vital capacity, timed vital capacity and maximal breathing capacity were measured by COLLINS' type spirometer using direct writing and integral pens. Oxygen cost of breathing was measured by the method similar to that described by BADER and others. Respiratory valve was constructed by connecting two "J" valves, which occupied dead space of 60 ml including mouth piece. The inspiratory side of the valve was left open to room air and the expiratory. side was connected to TISSOT's respirometer. Test was performed in the early morning during the post-absorptive status and in sitting position. After the collection of 3 minutes' ventilation, subjects were encouraged to perform voluntary hyperventilation reaching up to 10, 15, 20 and over 20 l/min. if possible. Expired air was analyzed into oxygen and carbon dioxide content using SCHOLANDER'S microgasanalyzer. Results : Significant reduction in vital capacity was observed in two cases of grade 3 mitral stenosis and a case of grade 3 mitral regurgitation, remaining 18 cases have shown normal or minimally reduced vital capacity. No case has shown significant reduction in MBC and timed vital capacity. While, oxygen cost of breathing was significantly higher in all three cases of grade 3 group, and no significant increase was observed in all the cases of grade 1 and 2 group. Positive and negative correlations were found between oxygen cost of breathing and mean pulmonary arterial pressure and cardiac index, respectively. Especially higher correlation was found between oxygen cost of breathing and mitral valvular orifice estimated at the time of com-missurotomia. In three cases, oxygen cost of breathing significantly reduced postoperatively. Conclusion : Oxygen cost of breathing ap-pears to be more sensitive test reflecting the tightness of mitral valve as compared to vital capacity, timed vital capacity and maximal breathing capacity.
- 1966-09-20
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