慢性閉塞性肺気腫の重症度設定と,それにもとづいた肺血行力学的観察
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Pulmonary hemodynamics in chronic obstructive pulmonary emphysema was investigated by the criteria of severity. 1. Ventilatory function test, blood gas analysis and static lung compliance were determined in 133 cases of chronic obstructive pulmonary emphysema. The right heart catheterization was carried on and the pulmonary and right ventricular dynamics were determined in 40 of 133 cases. 2. Referring Sa O_2, % RV and % 1" VC estimated by the routine respiratory function test, four grades of severity of the disease were defined. The 2nd grade was further subdivided into IIa, b and c by Sa O_2. Sa O_2 in the 2nd grade was almost more than 87% except lie which was few in nbumre. 3. In the blood gas constituents, decrease in Pa O_2 became markedly with severity. Increase in Pa CO_2 was not found strikingly due to its slow shift until the III, which showed reduction in pH as well. The static lung compliance was increased as the severity of the disease was advanced. 4. Among the X-ray findings of the chest, abnormal transparency could hardly be noted in the grade I. The lower stand of the diaphragm and the increased "Thorax-hoehe" (Marx) could be observed in the grade II. Increase in breadth of the shadow of the right pulmonary arterial descending branches became evident in the grade III. 5. About Ecg, the signs of the right ventricular overload could be distinctly seen in the grade III. Elevation of the venous pressure as well as prolongation of circulation time became evident in the grade II. Red blood cell counts, Hb., corpuscular volume, R.P.F., G.F.R. and F.F. were also available. 6. In the pulmonary hemodynamics, tendency to pulmonary hypertension was observed in the grade II. As the severity was advanced, Wp and E'p were augmented corresponding to pnlmonary hypertension, i.e. there could be seen pulmonary arterial hypertension of the W+E' type. 7. The cardiac index C.I. varied widely in each grade of the severity. As a whole there was no tendency to high output. However, in the transition period from the grade II to III, especially in the grade He, a remarkable tendency to high output could be observed. C.I. tended to be more or less reduced in the grade III. 8. As the severity of the disease was advanced, right ventricular dynamics showed tendency to the distinct pressure reaction. Pulmonary hypertension with the M type in the grade lie tended to show the pressure reaction in contrast to the volume reaction in the grade I with high output (concordant). The former was thought the discordant pattern. 9. Chronic obstructive pulmonary emphysema may be classified into the compensated, decompensated and recompensated stage by clinical symptoms. Although the pulmonary hemodynamics was markedly improved in recompensation, the pressure reaction of the right heart was not reduced remerkably. Therefore, it may be concluded that even after accomplished recompensation, the after-care seems still necessary.
- 千葉大学の論文
- 1964-11-28
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