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I.緒言
呼吸困難が心肺性障害における最も重要な臨床所見の1つであることは,今更多言を要しないところである。Richards1),上田教授2)等によると,呼吸困難とは,呼吸器障害によつて活溌に呼吸をいとなみ得ない場合に発現する一種の病的感覚と考えられるから,これを客観的に評価することは極めて困難といえよう。しかし,呼吸困難の発現に際し,しばしば努力呼吸を伴なうところから,後述する如く,努力呼吸の程度によつて呼吸困難の程度を客観的に指標化しようとする試みがある。
一方,ヒステリー等の心因性呼吸困難において努力呼吸が伴なわず,また昏睡時の努力呼吸に呼吸困難の感覚が欠けることは,周知の事実である。以上は呼吸困難の発生機構上,呼吸機能障害と同時に中枢感受性の役割が極めて重要であることを示唆するものであろう。
In this study, dyspnea in the aged chronic pulmonary patients was examined from the points of view of ventilatory inpairment and cerebral circulatory insufficiency.
1) The combined ventilatory inpairment (timed vital capacity (one second) /vital capacity ×100< 70%, % vital capacity <80%) was noted in 16 cases out of 19 cases and the expiratory incompetency (timed vital capacity (1")/vital capacity×100<70%) was noted in 3 cases out of 19 cases of the aged chronic pulmonary patients having with dyspnea.
2) The significant relationship between dyspnea and maximal breathing capacity, breathing reserve index, particularly between dyspnea and maximal breathing capacity was found.
From above results, it is inferred that maximal breathing capacity may be applied clinically as a measure of the intensity of the dyspnea in the aged chronic pulmonary patients having with dyspnea.
3) The intensity of the dyspnea was more decreased in the aged having with advanced cerebral arteriosclerosis than slight cerebral arteriosclerosis.
From these gap between the subjective dyspnea and the objective ventilatory inpairment, it is supposed that the general examination from the points of view of cardiopulmonary function is necessary for recognizing dyspnea in the aged.
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