肺内循環障害についての一考察 : とくに,肋膜癒着症例における肺血行動態に関する臨床的,ならびに,実験的考察

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1) About 139 cases of primary pulmonary cancer patients, surgically operated in our research hospital during 1963〜1968, we analyzed probability of pleural adhesion and interrelationship between these and infiltration of cancer to the pleural surface. We found, in 84% of cases, various kinds of pleural adhesion on some places of pleural surface, and 77% of these had positional-relationship to cancer-infiltration at pleura. 87% of pleural adhesion were fibrous or scar and these suggested continuous occurrence of inflammation in lung parenchyma before growth of cancer. 2) Before thoracotomy, we examined pulmonary function-test by spirograph and bronchospirograph and nearly at the same time, we measured right and left pulmonaryblood-flow ratio by scinti-photograph, using ^<131>I.M.A.A.. We found inclination of oxygen-uptake-decrease and pulmonaryblood-flow-ratio dimunition in these lung, in which whole pleural-surface adheared to thoracic wall. 3) Intending to clear up the mechanism which caused pulmonary blood flow dimunition in these lung, we attempted per fusion experiments of isolated lung or lung-lobe, excised from 113 mongrel dogs, weighting 6〜15kg. Pulmonary vascular resistance was studied, as a function of both transpulmonary pressure and lung volume, at low constant blood flow (0.86〜0.95 mZ/sec), under negative pressure changes. In some experiments, excised diaphragmatic piece was pasted on fhe whole costal face of diaphragmatic lobe, and in some cases, bronchus of diaphragmatic lobe or bronchi of both cardiac, and apical lobe were completely obstructed and influence of these experimental constriction to vascular resistance and lung volume were studied. In other experiments, we also pasted micro diaphragmatic piece (5 mm diameter) at the center of costal face of diaphragmatic lobe, and after blood per fusion, we tried to wash out red cells in the alveolar capillaries directly under these micro-constriction, by low molecular weight dextran (L.M.W.D.) per fusion. In these experiments, we attempted to study regional microcirculatory-changes directly under the micro-constriction, microscopically. 4) In non constricted lung lobe, or non constricted lung, during negative pressure inflation, vascular resistance was found to be lowest at -10〜-15cm H_2O (T.P.P.) and at deflation state it was lowest at -5〜-7cm H_2O. (U-shaped curve) When bronchus of diaphragmatic lobe or bronchi of both cardiac and apical lobe were completely obstructed, courses of pulmonary vascular resistance as a whole lung were found to be rect-linear, if plotted against negative pressure. (T.P.P.) In these experiments minimal value of vascular resistance was observed when lung volume reached maximal at -20〜-25cm H_2O (T.P.P.). These observation suggested the possibility of pulmonary blood flow decrease during negative pressure deflation in experimentally constricted lung or lung-lobe. 5) After blood per fusion, in the alveolar capillaries directly under the micro-constriction, many red cells were observed, piled up one above another. If the L.M.W.D. were per fused, at the time point which the lung volume reached maximum (-20〜-25cm H_2O T.P.P.), these red cells were completely washed out from the alveolar capillaries directly under the micro-constriction. But, when L.M.W.D. were per fused at negative-pressuredeflation-state, even when the vascular-resistance as a whole was found to be lowest, many red cells were found at the same place. These observation suggested the possibility that in the vascular-system directly under the micro-constriction, vascular resistance was elevated at the deflation state, as observed in experimentally constricted lung or lung-lobe. 6) From these observation in per fusion-experiments, we could get useful suggestion about the mechanism which Caused pulmonary blood flow diminution in the lung when its pleural surface adheaed to thoracic wall completely. Simultaneously these observation also possibly explain the mechanism of regional pulmonary blood flow diminution which may probably followed regional ventilatory constriction in the lung.
千葉大学の論文

肺内循環障害についての一考察 : とくに,肋膜癒着症例における肺血行動態に関する臨床的,ならびに,実験的考察

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