前,および,後毛細管性肺疾患における肺圧縮率と気道抵抗について

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1. Pulmonary compliance and resistance to flow in the air-way were examined on 69 cases of bronchial asthma and 25 cases of chronic obstructive pulmonary emphysema. Methods : Using the electropneumotachometer made by Nippon Koden Co., pulmonary compliance was measured from the end-point of expiration to the 0.5 L. point of inspiratory phase during the quiet and somewhat deeper ventilation. Resistance to flow in the air-way was estimated by the volume step method. All cases were classified by our criteria on the severity of obstructive pulmonary diseases into four groups, i.e. from the zero to III, about which Hasegawa described in this journal (Vol. 40 : 427-450, 1964). Results : 1. Compliance at quiet respiration in normal health remained almost unchanged against the change in duration of inspiration or in respiration rate within a range of the ventilatory volume from 300 to 400ml.. Compliance in bronchial asthma as well as in pulmonary emphysema, however, was reduced during the respiration at slower or faster respiration rates than normal ; this tendency became more marked, as the degree of severity was advanced. In pulmonary emphysema, prolonged inspiration reduced compliance, which might be due to difficulty in obtaining a static compliance under these circumstances (Fig. 8-9). Air-way resistance also showed a similar tendency (Fig. 8-10). 2. The two-folded deep inspiration procedure caused the fluctuation of compliance within an almost normal range in cases of the severity ,of the degree zero to III. Influences of this procedure upon compliance could hardly be observed in the patients complicated with right cardiac failure (Fig. 12). 3. The combined nebulization with surface tension activator and broncho-dilator occasionally increased compliance supernormally in the patients of the severity of the degree zero and I. However the nebulization could augment compliance only up to a half of normal extent in the patients of the severity of the degree II and III. There could hardly be seen any effect of this nebulization upon compliance in the patients with right cardiac failure (Fig. 14). 4. Pulmonary compliance might be changed by hypoxaemia in cases of no marked signs of right cardiac failure or pulmonary fibrosis (Fig. 16). 5. Development of hypercapnia augmented compliance in bronchial asthma in contrast to pulmonary emphysema (Fig. 17). In summary, diffuse pulmonary diseases, above all, severe chronic obstructive pulmonary emphysema causes a reduction in compliance owing to interstitial fibrosis. The lungs of such cases become stiffer, which consequently augments the work of ventilation. In the presence of pulmonary hypertension, so far as examined by O. Bayer and R. Knebel method, blood vessels are assumed to act as erectile tissue within lung parenchyma. The compliance consequently seems to be low. II. Pulmonary compliance in cardiac decompensation due to various sorts of heart diseases, especially, mitral stenosis : Compliance and resistance were measured before, during and after digitalis therapy. The available data were obtained only from 20 of 52 cases on which acutual measurements were performed. 1. The compliance of the patients with valvular heart diseases measured before, immediately after full digitalization and at discharge from hospital were 0.09, 0.14 and 0.14 L/cmH_2O on the average. In other words, compared to the control value "before", the increase in compliance was, on the average, +39.2% immediately after digitalization and +41.4% at discharge from hospital (Fig. 21). 2. A relationship might exist between the duration of clinical signs and the improvement of compliance after digitalization. A marked improvement of compliance was usually obtained by digitalization in patients having less than three years of history. Such improvement, however, was seen only in a few patients with long history. Compliance in aortic insufficiency was generally found small as compared with that in mitral valvular diseases ; Marked cardiac enlargement in the thoracic cavity restricted the lung excursion and a long duration to decompensation appeared to play a role to enhance rigidity of lung. As a rule, it is hard to recover completely from decompensation in aortic insufficiency, if once occurred. Therefore, a clearcut improvement of compliance might not be seen in the cases of decompensated aortic regurgitation (Fig. 22). 3. The change in air-way resistance before, immediately after digitalization and at discharge from hospital (Fig. 23) : As compared with the value before digitalization, air-way resistance was decreased, on the average, -32.1% immediately after full digitalization and -38.6% at discharge from hospital. 4. Influences of the two deep inspiration procedure upon compliance of cardiac patients (Fig. 24) : The compliance remained unchanged by this procedure before digitalization, but it was increased, on the average, +5.8% immediately after digitalization and +12.1% at discharge from hospital. The effect of the two deep inspiration procedure on air-way resistance measured simultaneously with compliance (Fig. 25) : No definite tendency could be seen in air-way resistance. However, three patients whose air-way resistance was decreased 50% by nebulization of a broncho-dilator, also showed moderate reduction of air-way resistance by this procedure alone. 5. The change in compliance before and immediately after the nebulization of 0.3 ml. of broncho-dilator plus 2.0 ml. of surface tension activator (Fig. 26) : Increase in compliance was occurred, on the average, +9.9% immediately after digitalization and +10.0% at discharge from hospital, as compared with unchanged compliance before digitalization. 6. The nebulization could not bring striking change in air-way resistance alone. Yet the value of air-way resistance, which once had widely varied, tended to return towards a normal range, as the general therapeutic effects got noticeable. 7. Effects of respiration rate on compliance in normal health and cardiac diseases, when tidal volume was almost equaled to ventilatory volume of natural respiration (Fig. 28) : In normal health, despite of change in respiration rate, compliance remained almost constant, whereas it was reduced in cardiac diseases at the respiration rates below 14 as well as over 23 per minute. This reduction in compliance became slighter in recompensation. In summary, there is often increased pressure in the pulmonary circuit in various kinds of heart diseases, especially in decompensated mitral stenosis ; Pulmonary resistance is augmented and pulmonary hypertension ensues. The morphological change in pulmonary circuit offers further resistance to perfusion. The alveolar-capillary membrane also becomes thickened, and with onset of congestive failure, oedema of alveoli and interstitium develops; these pathological findings are all cumulative and lungs become progressively stiffer, thus the compliance falls.
千葉大学の論文
1965-07-28

前,および,後毛細管性肺疾患における肺圧縮率と気道抵抗について

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