換気力学からみた治療の問題点 気管支拡張剤の作用機序を中心として
閉塞性肺疾患における気道抵抗の増大, 吸気の肺内不均等分布は呼吸不全成立への重要な因子となるものであり, その対策として気管支拡張薬の投与が普遍的に取り入れられている. 交感神経刺激剤としてのイソプロテレノールは, 気管支喘息患者における自覚症の改善, 気道抵抗の減少, 時限肺活量の増大などによりその有用性が確認されてきているが, 反面気管支拡張剤エロゾル吸入後, 動脈血Po2は低下するという報告1)～3)が近年注目されてきている. Knudsonら2)は気管支喘息患者においてイソプロテレノール吸入後(A-a)D増大, Fco, DLCOの低下を観察し, 吸入によって換気の良好な部位の換気量が...
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| Published in | 医療 Vol. 28; no. 11; pp. 968 - 977 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 国立医療学会
1974
医療同好会 |
| Online Access | Get full text |
| ISSN | 0021-1699 1884-8729 |
| DOI | 10.11261/iryo1946.28.968 |
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| Abstract | 閉塞性肺疾患における気道抵抗の増大, 吸気の肺内不均等分布は呼吸不全成立への重要な因子となるものであり, その対策として気管支拡張薬の投与が普遍的に取り入れられている. 交感神経刺激剤としてのイソプロテレノールは, 気管支喘息患者における自覚症の改善, 気道抵抗の減少, 時限肺活量の増大などによりその有用性が確認されてきているが, 反面気管支拡張剤エロゾル吸入後, 動脈血Po2は低下するという報告1)～3)が近年注目されてきている. Knudsonら2)は気管支喘息患者においてイソプロテレノール吸入後(A-a)D増大, Fco, DLCOの低下を観察し, 吸入によって換気の良好な部位の換気量がなお一層増加し, 肺内VA/Q分布不均衡が更に増大したためとしている. 気管支喘息発作時における呼吸抵抗の増大は区域, 亜区域気管支などの比較的大気管支領域の狭窄によるものであって, いわゆるSmall airwayの病変の肺抵抗に関与する比率は小さく,4) 従来あまり重視されなかった. |
|---|---|
| AbstractList | 閉塞性肺疾患における気道抵抗の増大, 吸気の肺内不均等分布は呼吸不全成立への重要な因子となるものであり, その対策として気管支拡張薬の投与が普遍的に取り入れられている. 交感神経刺激剤としてのイソプロテレノールは, 気管支喘息患者における自覚症の改善, 気道抵抗の減少, 時限肺活量の増大などによりその有用性が確認されてきているが, 反面気管支拡張剤エロゾル吸入後, 動脈血Po2は低下するという報告1)～3)が近年注目されてきている. Knudsonら2)は気管支喘息患者においてイソプロテレノール吸入後(A-a)D増大, Fco, DLCOの低下を観察し, 吸入によって換気の良好な部位の換気量がなお一層増加し, 肺内VA/Q分布不均衡が更に増大したためとしている. 気管支喘息発作時における呼吸抵抗の増大は区域, 亜区域気管支などの比較的大気管支領域の狭窄によるものであって, いわゆるSmall airwayの病変の肺抵抗に関与する比率は小さく,4) 従来あまり重視されなかった. |
| Author | 金原, 章郎 石川, 皓 岩倉, 治男 小貫, 喜久子 古徳, 利光 関, 重弘 |
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| References | 21) Tai, E. &Read, J.: Blood gas tensions in bronchial asthma, Lancet, 1, 644, 1967 23) Ciba Guest Symposium: Thorax, 14, 286, 1959 20) Otis. A. B., Mckerrow, C. B., Bartlett, R. A. et al.: Mechanical factors in distribution of pulmonary ventilation, J. Appl. Physiol., 8, 427, 1955 12) Mead, J., &Whittenberger, J. L.: Physical properties of human lungs measured during spontaneous respiration, J. Appl. Physiol., 5, 779, 1953 11) Milic-Emili, J., Mead, J., Turner, J. M. &Glanser, E. M.: Improved technique for estimating pleural pressure from esophageal balloons, J. Appl. Physiol., 19, 207, 1964 1) Graham, W. G. B., Heim, E. &Constantine, H. P.: Sequential studies of airway resistance in normal and asthmatic subjects, Am. Rev. Resp. Dis., 92, 317, 1965 25) 石川皓: 第14回日本胸部疾患学会総会, シンポ, 呼吸機能の問題点 (9) -大気汚染と呼吸機能の評価- 2) Dynamic complianceの周波数依存性, 発表, 昭和49. 4. 於東京 2) Knudson, R. J. &Constantine, H. P.: An effect of isoproterenol on ventilation-perfusion in asthmatic versus normal subjects, J. Appl. Physiol., 22, 402, 1967 6) Anthonisen, N. R., Bass, H., Oriol, A., et al.: Regional lung function in patients with chronic bronchitis, Clin. Sci., 35, 495, 1968 15) Jones, N. L., McHardy, G. J. R., Naimark, A., et al.: Physiological dead space and alveolar-arterial gas pressure differences during exercise, Clin. Sci., 31, 19, 1966 24) Medical Research Council (MRC) Working Party: Lancet, 1, 775, 1965 17) Raine, J. M. &Bishop, J. M.: A-a difference in O2 tension and physiological dead space in normal man, J. Appl. Physiol., 18, 284, 1963 10) Waddell, J. A., Emerson, P. A. &Gustone, R. D.: Hypoxia in bronchial asthma, Brit. Med. J., 2, 402, 1967 3) Tai, E. &Read, J.: Response of blood gas tensions to aminophylline and isoprenaline in patients with asthma, Thorax, 22, 543, 1967 14) Ledbetter, M. K., Bruck, E. &Fahri, L. E.: Perfusion of the underventilated compartment of the lung in asthmatic children, J. Clin. Invest., 43, 2233, 1964 22) Levine, G., Housely, E., MacLeod, P. &Macklem, P. T.: Gas exchange in mild bron-chitis and a asymptomatic asthma, New Engl. J. Med., 282, 1277, 1970 4) Macklem, P. T. &Mead, J.: Resistance of central and peripheral airways measured by a retrograde catheter, J. Appl. Physiol., 22, 395, 1967 18) Lorriman, G.: The effects of bronchodilators on pulmonary ventilation and diffusion in asthma and emphysema, Thorax, 14, 146, 1959 8) McFadden, E. R., Jr. &Lyons, H. A.: Airway resistance and uneven ventilation in bronchial asthma, J. Appl. Physiol., 25, 365, 1968 9) Hecksher, T., Bass, H., Oriol, A., et al.: Regional lung function in patients with bronchial asthma, J. Clin. Invest., 47, 1063, 1968 13) Williams, M. H., Jr., &Zohman, L. R.: Cardiopulmonary function in bronchial asthma, Am. Rev. Resp. Dis., 81, 173, 1960 16) Filley, G. F., Gregoire, F. &Wright, G. W.: Alveolar and arterial oxygen tension and the significance of the alveolar-arterial oxygen tension difference in normal men, J. Clin. Invest., 33, 517, 1954 19) Raine, J. M. &Bishop, J.: Alterations in ventilation-perfusion relationships in the lung after breathing inert dust or bronchoconstrictor aerosols and after short periods of voluntary hyperventilation, J. Clin. Invest., 43, 557, 1964 7) Woolcock, A. J., Vincent, N. J. &Macklem, P. T.: Frequency dependence of compliance as a factor for obstruction in the small airways, J. Clin. Invest., 48, 1097, 1969 5) Hogg, J. C., Macklem, P. T. &Thurlbeck, W. M.: Site and nature of airway obstruction in chronic obstructive lung disease, New Engl. J. Med., 278, 1355, 1968 |
| References_xml | – reference: 15) Jones, N. L., McHardy, G. J. R., Naimark, A., et al.: Physiological dead space and alveolar-arterial gas pressure differences during exercise, Clin. Sci., 31, 19, 1966 – reference: 17) Raine, J. M. &Bishop, J. M.: A-a difference in O2 tension and physiological dead space in normal man, J. Appl. Physiol., 18, 284, 1963 – reference: 22) Levine, G., Housely, E., MacLeod, P. &Macklem, P. T.: Gas exchange in mild bron-chitis and a asymptomatic asthma, New Engl. J. Med., 282, 1277, 1970 – reference: 25) 石川皓: 第14回日本胸部疾患学会総会, シンポ, 呼吸機能の問題点 (9) -大気汚染と呼吸機能の評価- 2) Dynamic complianceの周波数依存性, 発表, 昭和49. 4. 於東京 – reference: 2) Knudson, R. J. &Constantine, H. P.: An effect of isoproterenol on ventilation-perfusion in asthmatic versus normal subjects, J. Appl. Physiol., 22, 402, 1967 – reference: 3) Tai, E. &Read, J.: Response of blood gas tensions to aminophylline and isoprenaline in patients with asthma, Thorax, 22, 543, 1967 – reference: 21) Tai, E. &Read, J.: Blood gas tensions in bronchial asthma, Lancet, 1, 644, 1967 – reference: 6) Anthonisen, N. R., Bass, H., Oriol, A., et al.: Regional lung function in patients with chronic bronchitis, Clin. Sci., 35, 495, 1968 – reference: 23) Ciba Guest Symposium: Thorax, 14, 286, 1959 – reference: 11) Milic-Emili, J., Mead, J., Turner, J. M. &Glanser, E. M.: Improved technique for estimating pleural pressure from esophageal balloons, J. Appl. Physiol., 19, 207, 1964 – reference: 12) Mead, J., &Whittenberger, J. L.: Physical properties of human lungs measured during spontaneous respiration, J. Appl. Physiol., 5, 779, 1953 – reference: 19) Raine, J. M. &Bishop, J.: Alterations in ventilation-perfusion relationships in the lung after breathing inert dust or bronchoconstrictor aerosols and after short periods of voluntary hyperventilation, J. Clin. Invest., 43, 557, 1964 – reference: 10) Waddell, J. A., Emerson, P. A. &Gustone, R. D.: Hypoxia in bronchial asthma, Brit. Med. J., 2, 402, 1967 – reference: 24) Medical Research Council (MRC) Working Party: Lancet, 1, 775, 1965 – reference: 7) Woolcock, A. J., Vincent, N. J. &Macklem, P. T.: Frequency dependence of compliance as a factor for obstruction in the small airways, J. Clin. Invest., 48, 1097, 1969 – reference: 5) Hogg, J. C., Macklem, P. T. &Thurlbeck, W. M.: Site and nature of airway obstruction in chronic obstructive lung disease, New Engl. J. Med., 278, 1355, 1968 – reference: 9) Hecksher, T., Bass, H., Oriol, A., et al.: Regional lung function in patients with bronchial asthma, J. Clin. Invest., 47, 1063, 1968 – reference: 1) Graham, W. G. B., Heim, E. &Constantine, H. P.: Sequential studies of airway resistance in normal and asthmatic subjects, Am. Rev. Resp. Dis., 92, 317, 1965 – reference: 8) McFadden, E. R., Jr. &Lyons, H. A.: Airway resistance and uneven ventilation in bronchial asthma, J. Appl. Physiol., 25, 365, 1968 – reference: 18) Lorriman, G.: The effects of bronchodilators on pulmonary ventilation and diffusion in asthma and emphysema, Thorax, 14, 146, 1959 – reference: 4) Macklem, P. T. &Mead, J.: Resistance of central and peripheral airways measured by a retrograde catheter, J. Appl. Physiol., 22, 395, 1967 – reference: 13) Williams, M. H., Jr., &Zohman, L. R.: Cardiopulmonary function in bronchial asthma, Am. Rev. Resp. Dis., 81, 173, 1960 – reference: 16) Filley, G. F., Gregoire, F. &Wright, G. W.: Alveolar and arterial oxygen tension and the significance of the alveolar-arterial oxygen tension difference in normal men, J. Clin. Invest., 33, 517, 1954 – reference: 14) Ledbetter, M. K., Bruck, E. &Fahri, L. E.: Perfusion of the underventilated compartment of the lung in asthmatic children, J. Clin. Invest., 43, 2233, 1964 – reference: 20) Otis. A. B., Mckerrow, C. B., Bartlett, R. A. et al.: Mechanical factors in distribution of pulmonary ventilation, J. Appl. Physiol., 8, 427, 1955 |
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| Snippet | 閉塞性肺疾患における気道抵抗の増大, 吸気の肺内不均等分布は呼吸不全成立への重要な因子となるものであり, その対策として気管支拡張薬の投与が普遍的に取り... |
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| Subtitle | 気管支拡張剤の作用機序を中心として |
| Title | 換気力学からみた治療の問題点 |
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