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

为了获得改善慢性呼吸衰竭患者围手术期管理的信息，本研究重点关注呼吸负荷补偿、防御性气道反射和呼吸困难问题。大鼠慢性重度负荷清醒模式下的呼吸和行为代偿研究表明，重度慢性通气负荷可诱导适应性反应，快速补偿被扰乱的酸碱平衡，通气活动缓慢而渐进地增加，同时与运动活动/代谢率的增加相匹配。针对防御性气道反射，对人体呼吸和吞咽反射的协调性进行了研究。本研究表明，肺体积的增加延长了咽部注射水引起的吞咽反射潜伏期，并减少了连续输水时的吞咽次数。此外，肺容量的变化调节了吞咽的时间，更多地参考了呼吸周期。这些观察结果表明，迷走神经介导的反射可能在吞咽速率的控制中发挥重要作用，以及根据呼吸周期控制吞咽的时间。从呼吸困难的研究中获得的最显著的结果是吸入速尿大大改善了实验引起的人类呼吸困难的感觉。研究了麻醉大鼠吸入速尿的作用机制。结果表明，吸入呋塞米对慢适应受体有增敏作用，对快速适应受体有脱敏作用。因此，肺伸展受体的激活和迷走神经刺激受体的抑制似乎是人类吸入速尿后呼吸困难感觉改善的最合理的解释。吸入速尿还能抑制麻醉动物对气道阻塞的行为反应，但不影响对躯体有害刺激的反应。该动物模型可用于研究呼吸困难的机制和治疗方法。少

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