<原著>肺挫傷に関する基礎的ならびに臨床的研究

Abstract

At present pulmonary contusion is of primary importance as a serious complication of blunt trauma to the chest due to traffic accidents. It is difficult to detect the true pathophysiological conditions in the immediate postinjury period because the onset of symptom is insidious. With more rapid diagnosis and aggressive management of pulmonary contusion, however, it seems likely these ill conditions will be improved, and also prognosis is excellent. In this study experimental pulmonary contusion was prepared using a newly devised method to 72 anesthetized guinea pigs. The evaluation was performed on the effected pulmonary parenchyma with pathophysiological and histological respects from the immediate postinjury. These results are as follows : (1) It was noticed that one form of respiratory distress syndrome (RDS) is present in the early stages. (2) There is no significant effect directly related to the hemodynamic status. (3) In the first stage after the onset of injury, edematous swelling of alveolar linings (mainly type I) is seen. In contrast, the pathological findings among the endothelial layer and the interstitial septa are in a lesser degree. (4) Histological evaluation of experimental pulmonary contusion in guinea pigs, using the crystal infusion method with the limit no effecting to the normal lung tissue indicated that edema is easily induced within alveolar lining cells and interestitial space and that RDS is more aggravated. (5) The use of mechanical ventilation with positive end expiratory pressure (PEEP) was effective in these pathological conditions. Accurate evaluation of early diagnosis and treatment for pulmonary contusion was reviewed in 36 cases of blunt chest injury showed respiratory fail immediately after the trauma. The results are these : (1) It is recognized that RDS is induced due to pulmonary contusion started in the early stages after blunt chest injury. (2) Measurement of A-aDO_2 in the immediate after emergency treatment is effectable to detect early stage of pulmonary contusion. (3) The chest X-ray film is not definite for early diagnosis of pulmonary contusion. (4) Pulmonary scintigraphy is a useful diagnosis method to detect the effected degree and areas of pulmonary contusion. (5) Pulmonary contusion did not have a pronounced effect on directly to the hemodynamic status. (6) The use of mechanical ventilation, especially positive end expiratory pressure (PEEP) was effective in terminating the illness. (7) The use of above mentioned was very effective to prevent aggravation of pulmonary contusion and that these prompt therapeutic methods were used actively in the immediate postinjury period in this series. In all cases of pulmonary contusion containning of 15 cases using PEEP, complete recovery was found.