小児気管支喘息の肺シンチグラムと動脈血ガス動態
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概要
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Studies were performed on the pulmonary scintigram in 57 cases of asthmatic children and acid-base balance in 33 cases. Also, the relationship between pulmonary regional blood flow taken by photoscintigram of six to eight focuses and clinical findings or acid-base balance were observed. The results were as follows.<BR>1. The irregular shadows in pulmonary area were recognizable in all cases with asthmatic crisis by scintigram and diminished or disappeared upon clinical improvement. However, about fifty percent of subjects remained to be positive in pulmonic irregular shadow without any physical findings ever few days after the occurence of attacks.<BR>2. The deteriolation of symptom referred to the degree of circulation disturbance in pulmonary area, i.e. eleven segments of flow disturbance in severe cases of asthmatic crisis, six to ten segments in moderate and below five in mind.<BR>3. PO<SUB>2</SUB>, PCO<SUB>2</SUB>, pH and B.E. in arterial blood of asthmatic children were indicated as follows.<BR>PCO<SUB>2</SUB> (mmHg) =10<SUP>-0.00134</SUP> (Po<SUB>2</SUB> (mmHg) -1248), r=-0.346<BR>PCO<SUB>2</SUB> (mmHg) =-6.16×pH+83.73, r=-0.779<BR>PO<SUB>2</SUB> (mmHg) =8.69×pH+6.53, r=0.409<BR>B.E. (mEq/L) =3.87×pH-31.11, r=0.881<BR>(r=correlation index)<BR>4. The decrease of arterial PO<SUB>2</SUB> was seen according the deterioration of clinical findings, and PCO<SUB>2</SUB> revealed to elevate as clinical deterioration enforced. Upon the break down of homeostatic mechanism, it was showed to be hypercapnic and hypoxemic. It was strongly suggested to require treatment when PO<SUB>2</SUB> showed below 60 mmHg or PCO<SUB>2</SUB> is above 40 mmHg in asthmatic children. pH of normol valve was seen in 65 % of subjects with asthmatic crisis and decreased in 23 %, while normal B.E. in 38 % and moderately decreased in 50 %.<BR>5. According to the degree of circulating defective area in pulmonary region, PO<SUB>2</SUB> was decreased with following relation.<BR>PO<SUB>2</SUB> (mmHg) =-1.27× (segment of defective area) +82.17, r=-0.648 No significant relation between PCO<SUB>2</SUB>, B.E., pH and regional pulmonary defect.<BR>6. The defects in regional pulmonary flow were seen remarkably in upper on lower in severe crisis.<BR>7. The regional pulmonary circulation defects showed in moderate degree when initial onset of attack was over four years of age, and duration of disease continued more than six years.
- 学校法人 昭和大学・昭和医学会の論文