慢性肺氣腫の人工氣腹療法に關する病態生理學的研究
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概要
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In 45 cases of chronic pulmonary emphysema treated with artificial pneumoperitoneum, the observations were made as to the lung volume, ventilatory function, circulatory hemodinamics, ventilation-perfusion relationships and diffusing capacity before and after the treatment. The ventilatory insufficiency, in many cases, was observed to be improved as a result of the increase of diaphragmatic movement or the decrease of pulmonary over-distension. However the circulatory disturbances were observed to be inclined to increase due to the impairment of blood distribution and to the increase of pulmonary vascular resistance, which is mainly attributable to the decrease of pulmonary vascular beds.In all patients, except one, residual volume and total lung capacity reduced substan-cially after pneumoperitoneum and the ratio of residual volume to total lung capacity (VR/TLC×100) also decreased. In many cases, were observed the considerable increase in maximal breathing capacity, intra pulmonary gas mixing, arterial blood oxgen saturation and the decrease in pulmonary arterial pressure, pulmonary blood flow and work of right ventricle against pressure. However in several cases, the arterial blood oxygen saturation failed to increase, the pulmonary arterial pressure and the work of right ventricle were increased slightly.The ratio of dead space ventilation (VD/VE×100) was considerably reduced in general following the pneumoperitoneum. But in one case, this ratio increased slightly, and the arterial carbon dioxide pressure rose relatively. The evidence of disturbances in pulmonary circulation after pneumoperitoneum, as shown on one hand, by the increase in such factors as the venous admixture quotient, total pulmonary vascular resistance, right cardiac work and on the other hand, by the decrease in arterial blood oxygen saturation, suggests the difficulty to determine the indication of pneumoperitoneum for the treatment chronic pulmonary emphysema.
- 社団法人 日本内科学会の論文