仰臥位片肺分離換気中の低酸素性肺血管攣縮と肺血管内皮機能について

仰卧位单肺隔离通气时缺氧性肺血管痉挛与肺血管内皮功能

• 批准号: 12770847
• 负责人: 大石 羊子
• 金额: $ 1.15万
• 依托单位: Kurume University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Encouragement of Young Scientists (A)
• 财政年份: 2000
• 资助国家: 日本
• 起止时间: 2000 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-12770847/
• 关键词: アセチルコリン負荷試験; 肺血管内皮機能; 片肺換気; 低酸素血症; 低酸素性肺血管攣縮; 肺血管内皮機能検査; アセチルコリン; 肺血流分布; 肺ガス交換能; 片肺分離換気

近年胸部動脈瘤や肺腫瘍を含む胸部外科症例の増加により術中に片肺分離換気を必要とする症例が増加している。しかしながら、これまでの研究において重力などが片肺分離換気中の肺血流調節機構に関与することは示しているが、その直接の肺血流調節機構については推論の域を出ない。我々はアセチルコリン(Ach)負荷による肺血管内皮機能を評価し、片肺換気中の発生する低酸素性肺血管攣縮(HPVC)に対する肺血管内皮機能の影響について検討を行った。【対象】久留米大学倫理委員会より承認を得た(研究番号2023)。肺外科手術予定患者10名とした(平均年齢63歳、身長160cm、体重56kg)。胸部硬膜外チュービング後、全身麻酔を導入した。ダブルルーメンチューブを挿管後、右内頚静脈より肺動脈カテーテルを挿入した。測定項目は動脈圧、肺動脈圧(PAP)、PCWP、中心静脈圧、動脈血酸素分圧、混合静脈血酸素分圧、ヘモグロビン値、心拍出量とし、肺血管抵抗とシャント率を算出した。肺血管内皮機能検査としてAchを中心静脈路から10(-4)mol/L心拍出量で5分間持続投与した。側臥位両肺換気時、Ach投与直後、片肺換気時において測定した。【結果】肺動脈Ach負荷時体血圧の変動は無かった。Achの投与により平均PAPは低下し、PaO2/FIo2の値の低下とシャント率の上昇を認めた。平均PAPの低下値とPaO2/FIo2の値に相関関係を認めた(r=0.785、p<0.001)。さらに、両肺換気時Ach負荷時のPAPの低下と片肺換気中のPaO2/FIo2の値にも相関関係を認めた(r=0.849、p<0.016)。【考察・結語】PAPの低下とシャント率の上昇より、Achによる血管拡張は換気を有する肺胞に接している肺血管拡張よりも、HPVCにより収縮しているシャント血管である可能性が高い。また、Ach負荷時のPAP低下の程度(拡張機構)と片肺換気中の酸素化能(収縮機構)との間に負の相関を認めるため、肺血流調節機構上、相反する調節機構として存在することを示唆する。Ach負荷試験はこの調節機構の不均衡を検出する臨床的に有意義な検査であると考えられる。

In recent years, thoracic motor tumors and lung cancer include surgical cases of chest surgery, plus surgical treatment of lung cancer. In the study of gravity, the lung was separated from each other, and the pulmonary blood flow was detected by the pulmonary blood flow machine and directly by the pulmonary blood flow machine. We can use Ach to evaluate pulmonary vascular endothelialization and low-acid pulmonary vascular thrombosis (HPVC) to induce pulmonary vascular injury. [elephant] the committee of the Committee of Science and Technology of Jiulumi University will recognize Yaode (Research No. 2023). Ten patients (mean age 63 years old, length 160cm, body weight 56kg) were selected for lung surgery. After the epidural anesthesia of the chest, the whole body is numbed into the chest. In the back of the tube, the right side of the tube is closed. The right side of the tube is closed. Determine the items of exercise activity, pulmonary exercise test (PAP), PCWP, central sedation, kinetochol serum acid fraction, mixed intravenous blood acid score, heart beat volume, pulmonary vascular resistance test rate to calculate the blood acid score. The pulmonary vascular endothelium machine can measure the cardiac output of 10 (- 4) mol/L in the center of the Ach and hold the heart rate for 5 minutes. When the lungs were pressed, the Ach was injected straight back and the lungs were cut. [results] there was no change in the level of blood pressure during pulmonary Ach stress. Ach investment and average PAP is low, PaO2/FIo2 is low, and rate is high. The average PAP was lower (r = 0.785, P < 0.01) and PaO2/FIo2 was lower (P < 0.01). When the Ach was loaded, the PAP was lowered during the lung and lungs load. The PaO2/FIo2 concentration in the lung was significantly lower than that in the lung (r = 0.849, P < 0.01). [results] the incidence of low PAP infection was significantly higher than that of the control group, and the probability of blood vessel infection was higher than that of the control group. [results] there was a high probability that the lung cells were connected with the lung cells, the pulmonary blood vessels were infected, and the blood vessels were not detected in the patients with low PAP. [results] there was a high probability of vascular infection in patients with low levels of HPVC. The degree of low level of PAP during stress and Ach load (organ). The acidified energy in lung tissue (organ) was significantly higher than that in lung tissue (organ). The pulmonary blood flow was detected in the organ, and on the contrary, there was a sign of abstinence in the organ. Ach is responsible for the imbalance of the quality control system. It is the intention of the company to make an examination.