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Kokyu to Junkan Volume 34, Issue 7 （July 1986）

呼吸と循環 34巻7号（1986年7月発行）

Japanese English

研究

片側気道狭窄犬のV_A／Q分布に対するHigh Frequency Oscillatory Ventilationの効果 Effciency of high frequency oscillatory ventilation on V_A/Q distribution in the lung with unilateral large airway obstruction 古賀秀隆 ¹ , 一ノ瀬和博 ¹ , 貞松篤 ¹ , 須山洋之 ¹ , 宿輪昌広 ¹ , 黒部勝則 ¹ , 池田洋 ¹ , 久保進 ¹ , 今村俊之 ¹ , 原耕平 ¹ Hidetaka Koga ¹ , Kazuhiro Ichinose ¹ , Atsushi Sadamatsu ¹ , Hiroyuki Suyama ¹ , Masahiro Shukuwa ¹ , Katsunori Kurobe ¹ , Hiroshi Ikeda ¹ , Susumu Kubo ¹ , Toshiyuki Imamura ¹ , Kohei Hara ¹ ¹長崎大学第二内科 ¹The 2nd Department of Internal Medicine, Nagasaki University School of Medicine pp.749-756

発行日 1986年7月15日 Published Date 1986/7/15

DOI https://doi.org/10.11477/mf.1404204897

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Abstract 文献概要
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　High Frequency Oscillatory Ventilation （以下HFOVと略）は，Bohn^1）やButler^2）らの実験的研究や臨床応用に関する報告以来，その機序に関する研究が進められている。また正常肺や疾患モデル犬を用いた観察も報告^3〜10）され，その有用性が議論されている。今回我々は，気道狭窄を有する肺におけるHFOVのガス交換に対する効果を検討するため，tracheal dividerを捜管した雑犬を用いて，片側気道に種々の程度の狭窄器を取り付けたモデルを作成し，six inert gas techniqueを用いて連続的V_A／Q分布を解析し，HFOVが狭窄によるV_A／Q分布不均等を是正するかどうかを検討した。同時に，HFOVの気相側すなわち換気に対する効果を別個に観察するため，窒素洗出法を用いて，左右肺の有効換気量も測定した。

To investigate the efficiency of high frequency oscil-latory ventilation on the effective ventilation and gas exchange in the lung with airway obstruction, five alive dogs were ventilated through a unilaterally partially obstructed tracheal divider. Effective ventilation was measured using a multiple N₂ washout technique and the ratio of left side (obstructed) effective ventilation to right side (unobstructed) effective ventilation (VL/VR) was calculated. V_A/Q distribution was measured using inert gas elimination technique. The findings during HFOV were compared to those during CMV with varying degrees of obstruction (3.0, 1.7, 1.1, 0.6 mm I.D.).

About 15ml/kg of body weight as a tidal volume and 15/min frequency were applied during CMV. About 100ml stroke volume, 20Hz frequency and 15 liter/min bias flow were applied during HFOV, but, the tidal volume during CMV or stroke volume during HFOV were set variably to get normal PaCO₂ level. VL/VR ratios during HFOV with two severest obst-ructions were significantly (p<O.01) higher than during CMV with same obstructions. This finding sug-gested that HFOV improved the effective ventilation in left (obstructed) lung.

However, HFOV did not improve the V_A/Q mis-match which were seen during CMV with those severe obstructions and blood flow fractions to the area in which V_A/Q ratio was 0.1 or less were greater than during CMV and, then, PaO₂ during HFOV was lower than CMV although the effective ventilations during HFOV were greater than during CMV.

The volume of the right lung during HFOV were significantly greater than during CMV although the right airway pressure was almost identical to that during CMV. Left lung volumes during HFOV were significantly smalIer accompanying with lower airway pressure than during CMV. It was suggested that the lung volume alteration during HFOV might have resulted in the redistribution of blood flow (from right lung to left lung) and it might be the reason why the V_A/Q mismatch and low PaO₂ during CMV with severe obstruction were not improved by HFOV.