Studies for improvement of perioperative management for patients with chronic respiratory failure.

改善慢性呼吸衰竭患者围手术期管理的研究。

• 批准号: 11470316
• 负责人: NISHINO Takashi
• 金额: $ 9.22万
• 依托单位: CHIBA UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-11470316/
• 关键词: perioperative management; chronic respiratory failure; respiratory load compensation; defensivfe airway reflexes; swallowing reflex; inhaled furosemide; dyspnea; 慢性呼吸器疾患; 間質性肺炎; 周術期呼吸管理; 気道反射; 気道刺激

To obtain information for improvement of perioperative management of patients with chronic respiratory failure, this study focused on problems of respiratory load compensation, defensive airway reflexes, and dyspnea. The study on respiratory and behavioral compensation during chronic severe loading in an awake rat mode suggests that severe chronic ventilatory loading may induce adaptive response that compensate rapidly the disturbed acid-base balance with slow and gradual increases in ventilatory activity while matching the increase in motor activity/metabolic rate. Concerning the defensive airway reflexes, the coordination of respiration and swallowing reflex in human was investigated. This study showed that an increase in lung volume prolongs the latency of swallowing reflex elicited by bolus injection of water into the pharynx and decreases the number of swallows during continuous infusion of water. In addition, changes in lung volume modulated the timing of swallowing in reference … More to the respiratory cycle. These observations suggest that vagally-mediated reflexes may play an important role in the control of swallowing rate as well as the timing of swallowing in reference to the respiratory cycle. The most remarkable result obtained from the studies on dyspnea is that inhaled furosemide greatly improves the sensation of experimentally-induced dyspnea in humans. The mechanisms of this effect of inhaled furosemide were investigated in anesthetized rats. The results showed that inhaled furosemide sensitizes slowly-adapting receptors and desensitizes rapidly-adapting receptors. Thus, activation of pulmonary stretch receptors and inhibition of vagal irritant receptors seems to be the most plausible explanation for the improvement of dyspneic sensation following inhalation of furosemide in humans. Inhaled furosemide also suppressed the behavioral response to airway occlusion in anesthetized animals without affecting the response to somatic noxious stimulus. This animal model may be applicable to the study of dyspnea concerning its mechanism and treatment. Less

为了获得改善慢性呼吸衰竭患者围手术期管理的信息，本研究着重于呼吸负荷补偿、防御性气道反射和呼吸困难的问题。在清醒大鼠模式下进行的慢性重度负荷期间的呼吸和行为补偿研究表明，重度慢性呼吸负荷可能诱导适应性反应，该适应性反应通过缓慢和逐渐增加的呼吸活动快速补偿被扰乱的酸碱平衡，同时匹配运动活动/代谢率的增加。在防御性气道反射方面，研究了人类呼吸反射和吞咽反射的协调性。该研究表明，肺容量的增加延长了由向咽部推注水引起的吞咽反射的潜伏期，并减少了连续输注水期间的吞咽次数。此外，肺容量的变化调节了吞咽的时间， ...更多信息 呼吸周期的变化。这些观察结果表明，迷走神经介导的反射可能在控制吞咽速率以及吞咽时间与呼吸周期的关系中发挥重要作用。从呼吸困难的研究中获得的最显著的结果是吸入呋塞米大大改善了人类实验诱导的呼吸困难的感觉。在麻醉大鼠中研究了吸入呋塞米的这种作用的机制。结果表明，吸入速尿可使慢适应受体增敏，使快适应受体减敏。因此，肺牵张受体的激活和迷走神经刺激受体的抑制似乎是最合理的解释，改善呼吸困难的感觉吸入呋塞米后，在人类。吸入呋塞米还抑制麻醉动物对气道阻塞的行为反应，而不影响对躯体伤害性刺激的反应。该动物模型可用于呼吸困难机制和治疗的研究。少

项目成果

SUDO, T.: "Responses of tacheobronchial receptors to inhaled furosemide in anesthetized rats"Am J Respir Grit Care Med. 162. 971-975 (2000)

SUDO, T.：“麻醉大鼠中支气管受体对吸入呋塞米的反应”Am J Respir Grit Care Med。

石川輝彦: "胃食道逆流症と気道反応"人工呼吸. 17. 33-37 (2000)

Teruhiko Ishikawa：“胃食管反流病和气道反应”人工呼吸 17. 33-37 (2000)。

田中敦子: "周術期における上気道と呼吸合併症"臨床麻酔. 23. 1856-1863 (2000)

Atsuko Tanaka：“围手术期的上呼吸道和呼吸系统并发症”《临床麻醉》23. 1856-1863 (2000)。

IDE, T.: "The effect of epidural anesthesia on respiratory distress induced by airway occlusion in isoflurane-anesthetized cat"Anaesth Analg. 92. 749-754 (2001)

IDE，T.：“硬膜外麻醉对异氟烷麻醉猫气道闭塞引起的呼吸窘迫的影响”Anaesth Analg。

KIJIMA, M.: "Modulation of swallowing reflex by lung volume changes"Am J Respir Crit Care Med. 162(5). 1855-1868 (2000)

KIJIMA, M.：“通过肺容量变化调节吞咽反射”Am J Respir Crit Care Med。