心・肺疾患の呼吸機能の研究,とくに循環動態との相関
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Classifying 40 cardiac patients into various groups, and besides judging subjective and objective findings, the respiratory function tests were performed in each group of slight, moderate and severe degree, Gaensler's 1st and milder cases within the 2nd group corresponded to the slight group, the 2nd and milder cases within the 3rd group to the moderate group, the 3rd and the 4th group to the severe group respectively. With due regard to the all clinical states, the mode of response caused by the administration of drugs were classified into the effective, unchanged and exacerbated. 7 cases with pulmonary emphysema, 5 with bronchial asthma, and one with hyperthyrosis were compared and contrasted with cardiac patients. In order to study the influence of postural change upon respiratory function, lung- and ventilation volumes were measured in lying and standing positions, and as circumstances require, also in sitting, with special reference to the relationship to circulatory dynamical factors. 1. The tidal volume of cardiac patients was in general found less than that of normal health, provided that in bronchospasm, cor pulmonale, pulmonary emphysema and bronchial asthma the tidal volumes were commonly determined larger than those in normal health. The patients with rales in any of groups tended to have the small tidal volume. 2. The respiratory minute volume in bronchial asthma was a little on the average, whereas in cardiac disorders it was rather larger than that in normal health. Expressly, in lying the patients with hyperthyrosis, auricular fibrillation and bronchospasm, and in standing, the patients with pulmonary emphysema, cor pulmonale and cardiogenic bronchospasm tended to show the higher R.M.V. than those of normal subjects. 3. The inspiratory capacities in pulmonary emphysema, cor pulmonale and bronchial asthma were used to be found within normal range both in lying and standing, while those capacities in cardiac disorders were often observed less than that in normal health. Especially, the cases with rales showed the low value. 4. The expiratory reserve volumes in pulmo-cardiac diseases were estimated subnormally, whereas those in cor pulmonale, pulmonary emphysema and bronchial asthma were relatively higher than those in cardiac diseases on the average. The cases with rales showed occasionally the marked low value. 5. The vital capacity in any group of cardiac diseases was measured less than that in normal health. V.C. in pulmonary emphysema, bronchial asthma existed usually with normal range. The patients suffered from rales showed frequently the very low value. 6. The maximal breathing capacity in any group of diseases observed here, especially in cardiogenic bronchospasm or cor pulmonale was determined less than that in normal health, whereas the left ventricular failure showed not so marked decrease on the average. M.B.C. of the cases with rales were commonly estimated low. 7. While the air velocity index in hyperthyrosis or auricular fibrillation was found longer than 1.0, in the other groups of diseases, particularly in cardiogenic bronchospasm, pulmonary emphysema and bronchial asthma A.V.I, were observed very low. In the cases with rales there could not bs ascertained any conclusive tendency to be affected. 8. The breathing reserve ratio all the diseased group through was less than 93% on the average. Expressly in cardiogenic bronchospasm and cor pulmonale there were measured the very low values, such as smaller than 70% in standing position. Those who showed less than 70 % were all of severe degree, moreover, mostly suffured from rales. 9. The striking subnormal O_2 Comsumption was not determined among whole cases. Especially in the groups with hypertensive cardiac disease, aortic regurgitation, cardiogenic bronchospasm, cor pulmonale and hyperthyrosis these values proved more or less high. The cases with rales or of severe degree showed the distinctly high values. 10. The O_2 equivalent in each group of diseases was ranged above the normal limits, particularly in mitral steno-insufficiency, coronary insufficiency, aortic regurgitation, auricular fibrillation and pulmonary emphysema there were estimated markedly large values. One hyperthyrotic case free from cardiac disorder showed the normal value. 11. The residual volumes in coronary insufficiency, cor pulmonale and pulmonary emphysema were measured twice as large as the normal value. The cases with rales showed often low values. 12. The residual volume ratio in each group of diseases was estimated beyond 26%, that is, above the normal mean value on the average. The cases with rales showed frequently fairly high values. 13. The arterial O_2 saturation below 90% on the average was found in mitral stenosis, coronary insufficiency or cor pulmonale; those of pulmonary emphysema and hyperthyrosis were determined more than 90%. The severe cases or those with rales of each group of diseases showed in general, utterly low values. Except that the venous O_2 saturations in hypertensive cardiac disease and hyperthyrosis on the average were found within normal limits, V. O_2 S. were usually determined beneath normal range. V. O_2 S. of the cases with rales were estimated between 35-65%, so that tfie existence of rales itself did not give any significant influence upon V". O_2 S.. 14. The arterial O_2 tension was subnormal all the group of disease through, expressly these tendencies could be found in mitral stenosis, coronary insufficiency, cardiogenic bronchospasm, cor pulmonale and pulmonary emphysema. The cases with rales, independently from the underlying diseases, showed less than 76mmHg on the average. The arterial CO_2 tensions in mitral stenosis, cardiogenic bronchospasm, cor pulmonale and pulmonary emphysema were occasionally found above the normal extent; the cases with rales had no constant tendency to be affected. 15. Ether times in hypertensive cardiac disease and hyperthyrosis existed relatively in the vicinity of the normal range, however those of the other groups were often found twice as much as high. In the group with cor pulmonale this value was not seldom markedly large. While Decholin time in hyperthyrosis was measured nearly within normal limits, those of the other groups were frequently prolonged. 16. Among the cases of severe degree there was not rarely seen the relative refractoriness of the respiratory findings against the medico-therapy in contrast to the circulatory improvement, whereas in slight or moderate cases the respiratory improvement was commonly parallel to the circulatory. In unchanged or exacerbated cases there were observed the various sorts of the other modes of responses. 17. Influence of postural change : The sorts of underlying diseases not substantially affected the mode of the postural response, but the cases of severe degree or with rales showed maximal response in standing, minimal in lying. The inspiratory capacity of the patients with rales was, as a rule, above the normal extent, namely the value in the standing or sitting was found larger than that in lying. The difference of the measurment due to postural change in bronchial asthma or pulmonary emphysema was ranged almost within normal limits. Concerning the expiratory reserve volume of the patients with rales or of severe degree, the value in sitting or standing did not necessarily larger than thai in recumbent. As to the vital capacity of the cases with rales or of severe degree, the value in standing was maximal, the one in lying minimal. The ratio of each postural change in pulmonary emphysema was measured within normal range. The maximal breathing capacity and the breathing reserve ratio had the similar tendency to that of the vital capacity. Among the patients of severe degree or with rSles, the inspiratory capacity in recumbent, was found less than the exspiratory reserve volume, but after the successful medico-therapy the cases with favourable effects showed the marked increase in the inspiratory capacity. There could be observed nearly the same tendency in standing or sitting, however the range of the response proved a little. There existed the fairly closed correlation between the size of lung- and ventilation volume and the sensation of breathlessness, about which various kinds of possibilities were dwelt upon in each example. 18. By means of the right heart catheterization respecting pulmonary vascular dynamics and pulmonary functions there could be obtained some supplementary contribution to the studies made by our collaborators Chiba, Tomii, Ihara, Mori and Sha which were already reported in this Journal and so on.
- 千葉大学の論文
- 1958-09-28