肺機能障害と拶循環障害の相関，特に肺気腫—老人における脳血管不全の発生機転について

A study on the mechanism of occurrences of cerebrovascular insufficiencies insenile patients with pulmonary emphysema.

I．緒言

　高度の脳動脈硬化を有する老人に，心筋梗塞の如き急激且つ高度の全身血圧低下を伴なう脳外性偶発症が発生した場合，著明な脳anoxia（脳血管不全cerebral vascular insufficiency）の発現し得ることがCorday^1）によつて報告せられている。また沖中教授^2）も生前に脳卒中症状を呈したにも拘らず，剖検上著明な解剖学的所見を認めない脳卒中の存在することを指摘し，且つ之の発生機転が心筋梗塞，肺炎等の脳外の主として心肺性障害に起因するとの老えから心脳卒中cardiocer—ebral apoplexyと呼び，之を通常の脳出血及び脳軟化に起因する脳卒中から区別している。

　更に動脈血chemical agent就中Pco₂が脳血行動態に対して直接的影響を及ぼし，hypercapniaに際して脳血管抵抗（CVR）減少，脳血流量（CBF）増加，またhypocapniaに際してCVR増加，CBF減少を来すということはKety^3）4），Schein—berg^5），Patterson^6），楊^7），岡田^8）氏等の指摘する所である。

In the Present study, function of pulmonary ventilation, component of blood, cerebral circulation, severity of ophthalmofundo-arteriosclerosis and renal function were examined in senile patients of pulmonary emphysema, with respects to relations of the above respective factor to cerebral symptoms (headache, dizziness). From these observations, it is suggested that not only cerebral arteriosclerosis and anoxemia but also functional spasm of cerebral blood vessels due to pulmonary disfunction were regarded as the factors involving of the occurrences of cerebral symptoms in senile pulmonary emphy-sema. It was also indicated that these phenomena were liable to occur in primary chronic pulmonary emphysema or senile pulmonary emphysema. In connection with these findings, pathophysiological studies indicated that when the senile patients of severe pulmonary emphysema with cerebrosclerosis, coronary insufficiency, systematic metabolic disorders, etc. were complicated with acute pulmonary diseases such as pneumonia, then cerebrovascular insufficiency was liable to occur after the development of anoxemia, respiratory acidosis and cardiac insufficiency. It was proposed that cerebral symptoms which were thought to occur as the results of pulmonary disfunction should be called as "pulmonary encephalopathy", and that cerebrovascular insufficiency in which pulmonary disfunction was thought to be the primary cause should be called as "pulmonary cerebrovascular insufficiency" or "cardiopul-mocerebral apoplexy", and therefore that these cerebral symptoms due to pulmonary disfunction should be distinguished from the other cerebral symptoms or cerebrovascular insufficiencies due to the factors excluding pulmonary disfunction.