呼吸不全の 3 症例

Abstract

種々の病因を背景とする長期入院の呼吸不全症例の3例を提示した。症例1は57歳, 男性。肺結核症のため, 両側人工気胸術後に発症した緑膿菌感染を伴う有瘻性膿胸及び大動脈弁閉鎖不全症による呼吸不全及び心不全症例で, ベッド上での生活が1年以上続いている。症例2は, 41歳, 男性。緑膿菌感染を伴う広汎な気管支拡張症及び肺性心症例で, 2-3日に1日は人工呼吸器による補助呼吸が必要である。症例3は27歳, 男性。家族性に発症した特異な分布を示す肺線維症症例で, 30歳時, 呼吸不全にて死亡した。欧米において試みられている肺あるいは心肺移植の適応例の考察から, これらの患者に対する移植術の可否及び適応となる術式について検討した。本邦では, 臓器移植に関する未解決, 未解明の問題点が山積しており, 今後の広汎かつ慎重な検討が望まれる。

Three patients with chronic respiratory failure of various etiology, who have (had) been in the hospital for some years, were presented. The case 1 is male and was 57 years old on admission. He has been suffered from right thoratic emphyma from October '83,which is under chronic infection of Pseudomonas aeruginosa, with bronchial fistula and aortic valve insufficiency. His pulmonary function is severly restrictive and the grade of his dyspnea has been V of Hugh-Jone's criteria and he is now unable to leave from bed. The case 2 is male and was 41 y.o. on admission. He has been ill with diffuse cystic bronchiectasis from 33 y.o. and bronchorrhea (>200ml/day) with chronic infection of Pseudomonas aeruginosa has been lasting and reccurent attacks of infection have progressively worsened of his pulmonary and cardiac functions. He is now indispensable to assist ventilation by artificial respirator every 2-3 days. The case 3 was male and 27 y.o. on admission. He had admitted because of severe dyspnea due to familial pulmonary fibrosis on August '86. His disorder had been progressive and resistant against repeated corticosteroid therapy. He died of respiratory failure at 30 years old. The transplantations of lung and heart-lung for critical patients with respiratory failure have been challenged in North America and Europe, but in Japan, many social and medical problems about transplantasion have yet been unresolved. The indications for and against lung or heart-lung transplantation to these three patients was discussed with reference to English literatures.