肺気腫の呼吸機能,および,血行力学にかんする知見補遺
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概要
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Fifty-three cases suffered from bronchial asthma with or without pulmonary emphysema were classified as follows. The group examined by the venous cardiac catheterization were divided into A and B, i. e. in the former the mean pulmonary arterial pressure (PAm) was measured beyond 20 mmHg, in the latter PAm was estimated below this level (Tab. 1-4). The group not examined by the catheterization were divided into A' and B', i. e. the former was complicated with pulmonary emphysema, the latter was free from it. Total lung capacity (TLC, % of predicted) and residual volume (RV): TLC×100% increased parallel to the duration of the affection (Tab. 9). RV: TLC×100% of the cases with high PAm was almost always found large, but PAm of the cases with large RV: TLC×100% was not necessarily high (Fig. 1). There existed the inverse correlation between arterial O_2 saturation grade (art. O_2 sat.) and PAm (Fig. 2). The cases with art. O_2 sat. below 90% showed PAm above 20 mmHg without exception. Between art. CO_2 content and PAm there was observed the right correlation. The cases with art. CO_2 cont. above 23 mM/L showed very frequently PAm beyond 20 mmHg (Fig. 3). The cases with reduced art. O_2 sat. among the group complicated with pulmonary emphysema showed once the decrease in the cardiac output Vm, on another occasion the increase. Even in the cases with Vm of normal range, the substantial Vm may be regard as slightly or moderately reduced due to their low art. O_2 sat. from the point of view of the oxygen supply to tissues. There could be formed the inverse relationship between total pulmonary resistance (TPR) and Vm as well as pulmonary arteriolar resistance (PAR) and Vm (Fig. 5). The pulmonary elasticity modulus (E'p) estimated by our modification of Knebel's method (Moriyama, the last number of this journal) was counted up 151 dyne cm^<-5> sec. as the averaged normal value where the pulmonary venous pressure (PV) was presumed equal to the pulmonary wedge pressure (PC).The averaged E'p of the cases with bronchial asthma free from pulmonary emphysema was estimated as 285 dyne cm^<-5> sec., whereas that of the cases complicated with emphysema was counted up 454 dyne cm^<-5> sec. (Fig. 6). In proportion to the increase in pulmonary systolic pressure, PAm and pulmonary pulse pressure, E'p tended to be elevated showing no correlation to pulmonary diastolic pressure. So far as our present study is concerned, there could not be any clear-cut relationship with ventilatory data, including oxygen consumption. E'p was found above 400 dyne cm^<-5> sec. in the cases with art. O_2 sat. below 95%. Fig. 7 shows TPR estimated in group A and B. The cases with more than three of four factors i.e. RV: TLC %≥40 %, E'p>250 dyne cm^<-5> sec., art. O_2 sat.≤95 % and art. CO_2 cont.>23 mM/L which were all importantly related to the pulmonary hypertension, were predominantly observed in the group A. The proviso must be added that the one case with the normal TPR in the group A showed the high output (9.31 L/min), that is, the minute volume type in the sense of Wezler-Boger (Text example 2). From the results obtained by the observation of maximal breathing capacity (MBG) and RV: TLC×100% (Fig. 8), breathing reserve ratio (BRR) and RV: TLC×100% (Fig. 9), in addition to those shown in Fig. 7, it may be safe to say that when the following four items i.e. RV %≥40 %, BRR<90 %, art. O_2 sat.≤95 % and art. CO_2 cont.>23mM/L are gratified, there can be taken for granted the existence of the pulmonary hypertension without the use of the venous catheterization so far as bronchial asthma with of without pulmonary emphysema, here observed, is concerned.
- 千葉大学の論文