<学術講演会抄録>呼吸不全の基礎と臨床

Abstract

Some experimental and clinical aspects in the problem of pulmonary insufficiency were discussed. Although physiologic shunt is one of the most important factors in the pathogenesis of hypoxemia, anatomic shunt also should be considered in the specific diagnostic situation. For example, lung spider nevi which is often observed on the lung surface of chronic liver disease patients, may account for intrapulmonary A-V shunt. A-V fistula of this type is difficult to visualize by ordinary roentgenologic study including angiography. The author demonstrated such micro A-V fistula by lung biopsy in a girl with cyanosis and clubbed fingers in whom calculated anatomic shunt was 30%. In the second place, the problem of site of hypoxic pulmonary vasoconstriction was discussed. The author measured the internal diameters in isolated lobe breathing hypoxic gas mixture using rapidly frozen method. The result showed that the site of constrictive response was muscular artery at the level of terminal or respiratory bronchiole. The rank correlation coefficient between fourth power of measured diameter and estimated change in shunt flow was +0.64. Lastly, clinical observations on postthoracotomy respiratory acidosis were presented. The results showed the presence of obstructive functional disturbance may affect the occurrence of postthoracotomy respiratory acidosis.