一酸化窒素吸入療法による肺摘除術後の急性右心負荷の改善検討

使用一氧化氮吸入疗法改善肺切除术后的急性右心负荷

• 批准号: 07771072
• 负责人: 田山 光介
• 金额: $ 0.51万
• 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: 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/grant/KAKENHI-PROJECT-07771072/
• 关键词: 一酸化窒素(NO); 肺摘除術; 急性右心負荷; 肺高血圧症; 術後低酸素血症

肺摘除の急性期における循環動態の把握,特にNOの肺動脈圧に及ぼす影響を検討した.(方法)ビ-グル犬を用い全身麻酔下に体血圧(BP)及び動脈血液ガスをモニタリングし,大腿静脈よりスワンガンツ カテーテルを挿入後,肺動脈圧(PAP),心拍出量(C.O.)を測定した.その後,右肺摘除を施行し直後,60′,120′にPAP,PaO2,COを測定.更に,PAPが一定となった120′からNOを5ppm吸入した.(結果)PAP(mean±SDmmHg)は術前,7.2±1.85,術直後,14.1±3.32^*,60′,12.0±2.67^*,120′,10.7±3.43(^*p<0.01 vs 術前値)また,NO吸入15′,7.6±2.22^*,30′,7.2±2.0^*,60′,7.0±1.94^*(^*p<0.01 vs 術後120′)であった.一方,C.O.(mean±SDL/min)は術前,1.26±0.44,術直後,1.73±0.39,120′,1.04±0.11,NO吸入後15′,1.07±0.06,60′,0.96±0.11で,PaO2(mean±SDmmHg)も術前,252.4±10.88,術直後,210.5±40.34,60′,207.9±42.9,120′,211.8±44.12,NO吸入後15′,232.4±23.6,30′,249.9±5.73′,60′,246.7±3.4と肺摘除,吸入NOともに術前値との有意差はなかった.(考察)肺摘除後は肺動脈圧が有意に上昇し徐々にadaptationがみられ2時間後には術前値と有意差はなく一定となる.この時点でNOを吸入すると15分後には選択的に肺動脈圧を是正した.吸入NOは体血圧及び心拍出量に影響せず肺循環のみに作用し安全かつ有効であった.また,術後急性期かつ強制換気中には低酸素血症はみられず,換気・血流不均等を改善するNOの作用も認めなかった.

To understand the circulation dynamics during acute pulmonary extirpation, especially to investigate the effects of NO on pulmonary arterial pressure and lung function. (Method) In dogs under general anesthesia, the body blood pressure (BP) and arterial blood pressure (ABP) were measured. After venous infusion, pulmonary arterial pressure (PAP) and cardiac output (C.O.) were measured. Measure it. PAP,PaO2 and CO were measured at 60 ′ and 120 ′ after right lung resection. In addition,PAP is 120 ppm and NO is 5ppm. PAP(mean± SD mmHg) decreased preoperatively from 7.2 ±1.85 to 14.1 ±3.32^*, 60 ′, 12.0 ±2.67^*, 120 ′, 10.7 ±3.43(^*p<0.01 vs preoperatively),NO inhalation from 15′, 7.6 ±2.22^*, 30 ′, 7.2 ±2.0^*, 60 ′, 7.0 ±1.94^*(^*p<0.01 vs postoperatively 120′). One side,C.O. (mean±SDL/min) preoperatively, 1.26 ±0.44, postoperatively, 1.73 ± 0.39, 120 ′, 1.04 ± 0.11, NO inhalation 15′, 1.07 ± 0.06, 60 ′, 0.96 ±0.11, PaO2 (mean± SD mmHg) before operation, 252.4 ±10.88, after operation, 210.5 ± 40.34, 60 ′, 207.9 ± 42.9, 120 ′, 211.8 ± 44.12, after NO inhalation, 15′, 232.4 ± 23.6, 30 ′, 249.9 ±5.73′, 60 ′, 246.7 ±3.4, after lung extraction, NO inhalation, before operation, 210.5 ± 40.34, 60 ′, 211.8 ± 44.12, 232.4 ± 23.6, 30 ′, 249.9 ±5.73′, 60 ′, 246.7 ±3.4. (Investigation) Pulmonary artery pressure after lung removal is intentionally increased, gradually adapted, 2 hours later, intentionally decreased, and definitely decreased before lung removal. At this time, NO was inhaled and 15 minutes later, the pulmonary pressure was positive. Inhalation of NO affects the pulmonary circulation, blood pressure and cardiac output. In the acute postoperative period, hypoacidemia and NO were observed during stress metabolism.