权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

経食道心エコー法による術後呼吸不全に対する低濃度一酸化窒素吸入の評価

经食管超声心动图评价低浓度一氧化氮吸入治疗术后呼吸衰竭

基本信息

批准号：
07671666
负责人：
加藤道久
金额：
$ 1.22万
依托单位：
The University of Tokushima
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至无数据
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-07671666/
关键词：
一酸化窒素吸入術後呼吸不全経食道心エコー法

项目摘要

術後呼吸不全患者5例に低濃度一酸化窒素(NO)吸入療法を施行し、肺動脈圧および動脈血酸素分圧の変化を調べ、術後呼吸不全に対するNO吸入の有効性を検討し、さらに経食道心エコー法を用い肺静脈血流波形、左室流入血流波形を測定し、一酸化窒素の左室拡張機能に及ぼす影響を検討した。なお、NO吸入については、本院の倫理委員会の承認を得た。呼吸回路内の二酸化窒素濃度の測定は0.1ppm以下であり、メトヘモクロビン濃度は吸入前0.8%、吸入後0.7%であり、低濃度NO吸入療法施行中の副作用は認めなかった。1.NO吸入前の動脈血酸素分圧は166.6mmHg、NO吸入中の動脈血酸素分圧は212.5mmHgであり、全例で上昇を認め、NO吸入が肺酸素化の改善に有効であった。肺動脈カテーテルを挿入し、全例で平均肺動脈圧と肺血管抵抗係数を求めたが、NO吸入前で32.2mmHg、424dynes・sec/cm^5・m^2、NO吸入中はそれぞれ29.4、307であり、平均肺動脈圧は4例で低下、肺血管抵抗は全例で低下し、NO吸入の選択的肺血管拡張作用を認めた。2.経食道心エコープローブ(アロカ社製)を挿入し、同様に一酸化窒素吸入前、吸入中にパルスドプラ法にて左室流入血流波形および肺静脈血流波形を測定し、それぞれS-VHSビデオおよびラインレコーダに記録し、各パラメータを測定した。十分な測定が実施出来たのは5例中2例であった。左室流入血流波形のPeak E/Aはそれぞれ0.88から1.09に、1.18から0.82に変化し、肺静脈血流波形のS/Dはそれぞれ0.81から0.79に、1.15から1.20に変化した。術後呼吸不全患者に対してもNO吸入療法が肺酸素化の改善に有効であり、選択的肺血管拡張作用を有することが明らかとなった。左室拡張機能に及ぼすNO吸入の影響は、NO吸入前の心機能を十分考慮する必要があると思われる。

5 patients with postoperative respiratory insufficiency were treated with low concentration nitric oxide (NO) inhalation therapy, pulmonary arterial pressure and arterial blood acid partial pressure were adjusted, the effectiveness of NO inhalation in postoperative respiratory insufficiency was evaluated, pulmonary venous blood flow waveform and left ventricular inflow waveform were measured by cardioesophageal echocardiography, and the effect of NO inhalation on left ventricular diastolic function was investigated. No inhalation, no admission by the Ethics Committee of our hospital. The concentration of NO in the respiratory circuit was determined to be below 0.1 ppm. The concentration of NO before inhalation was 0.8%. The concentration of NO after inhalation was 0.7%. The side effects of low concentration NO inhalation therapy were recognized. 1. Before NO inhalation, the arterial blood acid partial pressure was 166.6mmHg, during NO inhalation, the arterial blood acid partial pressure was 212.5mmHg, all cases increased, NO inhalation improved pulmonary acidosis. Pulmonary arterial pressure and pulmonary vascular resistance coefficient were calculated in all cases. Before NO inhalation, 32.2 mmHg and 424dynes·sec/cm^5·m^2 were calculated. During NO inhalation, 29.4 and 307 mmHg were calculated. Average pulmonary arterial pressure was decreased in 4 cases. Pulmonary vascular resistance was decreased in all cases. Pulmonary vascular relaxation effect of NO inhalation was recognized. 2. Esophageal heart failure was recorded before and during inhalation, and left ventricular inflow waveform and pulmonary vein waveform were measured by S-VHS. 2 out of 5 cases Peak E/A of left ventricular inflow waveform changed from 0.88 to 1.09, 1.18 to 0.82, S/D of pulmonary vein waveform changed from 0.81 to 0.79, 1.15 to 1.20. NO inhalation therapy has been shown to improve pulmonary acidosis in patients with postoperative respiratory insufficiency. The effects of NO inhalation on left ventricular systolic function are considered.