EFFECTS OF SUPERIMPOSED JET OSCILLATION ON FOUR INJURED LUNGS IN DOGS
The purpose of this study was to determine the effects of superimposed, jet oscillated ventilation (SOV) on 4 types of experimental acute lung injury, such as pulmonary edema, RDS, methacholine induced bronchial constriction, and histamine induced bronchial constriction. The PaO2 increased significa...
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| Published in | Journal of The Showa Medical Association Vol. 49; no. 1; pp. 47 - 57 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | English Japanese |
| Published |
The Showa University Society
1989
昭和大学学士会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0037-4342 2185-0976 |
| DOI | 10.14930/jsma1939.49.47 |
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| Abstract | The purpose of this study was to determine the effects of superimposed, jet oscillated ventilation (SOV) on 4 types of experimental acute lung injury, such as pulmonary edema, RDS, methacholine induced bronchial constriction, and histamine induced bronchial constriction. The PaO2 increased significantly only in the group with bronchoconstriction by methacholine when the ventilation support was changed from conventional mechanical ventiation (CMV) to superimposed 10 Hz-jet oscillation (SOV) during expiration. There was no significant difference in PaO2 between CMV and SOV in the three remaining subjects. Though Pa CO2 decreased easily under SOV in all injured lung groups compared to CMV, the respiratory phase in which jet oscillation decrease PaCO2 was not the same in injured lungs. There was no significant change in circulation between CMV and SOV in all subjects. The author conclude that SOV is better for gas exchange when pulmonary failure is the result of bronchoconstriction (induced by methacholine) . |
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| AbstractList | The purpose of this study was to determine the effects of superimposed, jet oscillated ventilation (SOV) on 4 types of experimental acute lung injury, such as pulmonary edema, RDS, methacholine induced bronchial constriction, and histamine induced bronchial constriction. The PaO2 increased significantly only in the group with bronchoconstriction by methacholine when the ventilation support was changed from conventional mechanical ventiation (CMV) to superimposed 10 Hz-jet oscillation (SOV) during expiration. There was no significant difference in PaO2 between CMV and SOV in the three remaining subjects. Though Pa CO2 decreased easily under SOV in all injured lung groups compared to CMV, the respiratory phase in which jet oscillation decrease PaCO2 was not the same in injured lungs. There was no significant change in circulation between CMV and SOV in all subjects. The author conclude that SOV is better for gas exchange when pulmonary failure is the result of bronchoconstriction (induced by methacholine) . The purpose of this study was to determine the effects of superimposed, jet oscillated ventilation (SOV) on 4 types of experimental acute lung injury, such as pulmonary edema, RDS, methacholine induced bronchial constriction, and histamine induced bronchial constriction. The PaO2 increased significantly only in the group with bronchoconstriction by methacholine when the ventilation support was changed from conventional mechanical ventiation (CMV) to superimposed 10 Hz-jet oscillation (SOV) during expiration. There was no significant difference in PaO2 between CMV and SOV in the three remaining subjects. Though Pa CO2 decreased easily under SOV in all injured lung groups compared to CMV, the respiratory phase in which jet oscillation decrease PaCO2 was not the same in injured lungs. There was no significant change in circulation between CMV and SOV in all subjects. The author conclude that SOV is better for gas exchange when pulmonary failure is the result of bronchoconstriction (induced by methacholine) . HFVの中でも振動重畳換気法 (SOVと略す) は, 比較的臨床応用が行われているが, 適応となる病態や有効な振動重畳時期などについては定説がない.したがって, この点の解明を目的として雑種成犬に4種類の呼吸不全を作成し, SOVの効果を比較検討した.25mg/kgのネンブタール投与下雑種成犬28頭を対象とし, 肺水腫群 (オレイン酸の静注N=7) , RDS群 (生理的食塩水の肺洗浄による脱サーファクタントN=6) , 2種類の気管支収縮群 (メサコリンN=8, またはヒスタミンN=7の持続点滴静注) などの病的肺を作成した.周波数が10Hzのジェット振動を吸気相, 呼気相, 全呼吸相に分けて重畳し, 病的肺作成前, 病的肺作成-IPPV施行1時間後, SOV開始後10・30・60分において各パラメータを採取した.肺水腫群とヒスタミン気管支収縮群ではどの呼吸相にSOVを施行してもPaO2はIPPV時とほとんど変わらなかったが, RDS群ではいずれの相に振動を重畳しても若干PaO2は上昇し, 一方メサコリン気管支収縮群では呼気相重畳時に有意に上昇した.また, PaCO2は, 全群においてSOVにより低下したものの, メサコリン気管支収縮群では吸気相で, 他の3群では呼気相と全呼吸相においてIPPV時との間に有意差が得られた.したがって, 各病態において酸素化と炭酸ガス排泄に関して有効な重畳時期は異なっていた.全群においてSOV施行による循環系への影響はほとんど認められなかった.以上のごとく, 4種類の呼吸不全に対して振動重畳時期を分けてSOVの効果を検討したが, IPPV時に比べて有意なPaO2の上昇が得られたのはメサコリン気管支収縮群の呼気相重畳時のみであり, 酸素化能改善に関しては適応となる病態は限られていた.また, 炭酸ガス排泄能に対する促進作用は各群で認められたが, 有効な振動重畳時期は酸素化能の改善が得られる呼吸相とは異なり解離していた.したがって, SOVはガス交換を促進するので, その有効性が期待されるものの, 酸素化能に対してIPPVより有効となる病態は比較的少ない事, 一方炭酸ガス排泄能は比較的広範囲の呼吸不全で認められる事などが示唆された. |
| Author | KONISHI, Yumiko |
| Author_FL | 小西 由美子 |
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| References | 15) 安本和正: 機械的人工呼吸の見直しと再評価-HFJV. 人工呼吸, 印刷中 4) 安本和正: 各種oscillation重畳による換気動態の変動. 人工呼吸 1 : 54-58, 1984. 12) 篠崎正博, 山下徳次郎, 杉山和英, 他: 重症呼吸不全患者におけるSuperimposed High Frequency Jet Ventilationの効果. ICUとCCU 6 : 975-981, 1982. 28) Gross, I.: Natritional and hormonal influences on lung phospholipid metabolism. Fed. Proc. 36 : 2665-2669, 1977. 23) Lefer, J.: Circulating currents during high frequency ventilation. Fed. Proc. 39 : 576, 1980. 2) 安本和正, 稲田豊: 高齢者に対する術中呼吸管理. 麻酔 35 : 91-98, 1986. 14) 安本和正: 新しい呼吸法I, 高頻度換気: 特に振動重畳換気法について. エレクトロニクスの臨床 49 : 19-26, 1984. 17) Owens, E. L., Lee, T. S., Wright, B. D., et al.: The effect of high frequency ventiration on the V/Q pattern in dogs with oleic acid lung damage. Anesthesiology 57 : A89, 1982. 16) 北村諭, 鈴木久美子, 石原洋子, 他: モルモット気管, 気管支系における気管支作動性物質の作用部位に関する研究. 日胸疾会誌 20 : 264-268, 1982. 29) 鏡勲: 安本和正: Inversed ratio ventirationが開心術後のガス交換能に及ぼす影響. 人工呼吸, 投稿中 1) 安本和正: 高頻度換気. 医学のあゆみ 129 : 1212, 1984. 10) 財津昭憲: 高頻度極短時間呼気遮断による呼気振動型呼気終末圧陽圧人工呼吸. 呼吸 3 : 794-801, 1984. 24) Wetzel, R. C., Gordon, J. B., Gregory, T. I., et al.: High-frequency ventilation attenuation of hypoxic pulmonary vasoconstriction. Am. Rev. Respir. Dis. 132 : 99-103, 1985. 30) Smith, D.W., Frankel, L.R., Ariagno, R. L., et al.: Dissociation of mean airway pressure and lung volume during high-frequency oscillatory ventilation. Crit. Care Med. 16 : 531-535, 1988. 18) Schuster, D. P., Snyder, J. V. and Klain, M.: Comparison of venous admixture during high-frequency ventilation and conventional ventilation in oleic acid induced pulmonary edema in dogs. Anesth. Analg. 61 : 735-740, 1982. 19) Thompson, W. K., Marchak, B. E., Froese, A. B., et al.: High-frequency oscillation compared with standard ventilation in pulmonary injury model. J. Appl. Physvol. 52 : 543-548, 1982. 9) 太田保世, 笹本浩: 振動呼吸法における血液ガス異常の改善. 厚生省特定疾患呼吸不全調査研究班, 昭和53年度研究業績: 1-5, 1979. 13) 宮野英範, 中川隆, 青地修, 他: 累積高頻度ジェット換気法. ICUとCCU 11 : 967-974, 1987. 27) Stiehm, E. R.: Humoral immunity in malnutrition. Fed. Proc. 39 : 3093-3097, 1980. 20) 山田芳嗣, 高橋久人, 樋口美栄子, 他: 重畳式高頻度振動換気法のオレイン酸肺水腫犬における肺ガス交換と換気力学. 麻酔 32 : 924-930, 1983. 7) Kuwasako, Y. and Yasumoto, K.: The Comparison of the conventional vertilation and HFJV on respiratory failure. In Proceedings of the 3rd WPCCM Congress, p. 119, 1985. 8) Wright, K., Iyrene, R. K., Truog, W. E., et al.: Ventilation by high frequency oscillation in rabbits with oleic acid lung disease. J. Appl. Physiol. 50 : 1056-1060, 1981. 25) 安本和正: 術後の栄養管理と肺機能. 人工呼吸 5 : 69-73, 1988. 21) Fredberg, J. J.: Augmented difusion in the airways can support pulmonary gas exchange. J. Appl. Physiol. 49 : 232-238, 1980. 11) 岡元和文: 高頻度断続的ジェット気流を重畳した間欠的気道内加圧法の研究-呼吸, 循環に及ぼす影響. 麻酔 30 : 911-919, 1981. 3) 佐藤俊男, 勝屋弘忠: 急性呼吸不全に対するHFV重畳法. ICUとCCU 10 : 1081-1083, 1986. 26) Arora, N. S. and Rochester, D. F.: Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am. Rev. Respir. Dis. 126 : 5-8, 1982. 5) 安本和正, 稲田登: Servo HFV unit使用時ジェット振動のタイプが換気力学に及ぼす影響について. 麻酔 34 : 173-179, 1985. 6) 桑迫勇登: HFJVが4タイプの実験的呼吸不全に及ぼす影響. 麻酔 34 : 1085-1094. 1985. 22) Haselton, F. R, and Sherer, P. W.: Bronchial bifurcations and respiratory mass transport. Science 208 : 69-71, 1980. |
| References_xml | – reference: 17) Owens, E. L., Lee, T. S., Wright, B. D., et al.: The effect of high frequency ventiration on the V/Q pattern in dogs with oleic acid lung damage. Anesthesiology 57 : A89, 1982. – reference: 16) 北村諭, 鈴木久美子, 石原洋子, 他: モルモット気管, 気管支系における気管支作動性物質の作用部位に関する研究. 日胸疾会誌 20 : 264-268, 1982. – reference: 11) 岡元和文: 高頻度断続的ジェット気流を重畳した間欠的気道内加圧法の研究-呼吸, 循環に及ぼす影響. 麻酔 30 : 911-919, 1981. – reference: 15) 安本和正: 機械的人工呼吸の見直しと再評価-HFJV. 人工呼吸, 印刷中 – reference: 6) 桑迫勇登: HFJVが4タイプの実験的呼吸不全に及ぼす影響. 麻酔 34 : 1085-1094. 1985. – reference: 20) 山田芳嗣, 高橋久人, 樋口美栄子, 他: 重畳式高頻度振動換気法のオレイン酸肺水腫犬における肺ガス交換と換気力学. 麻酔 32 : 924-930, 1983. – reference: 24) Wetzel, R. C., Gordon, J. B., Gregory, T. I., et al.: High-frequency ventilation attenuation of hypoxic pulmonary vasoconstriction. Am. Rev. Respir. Dis. 132 : 99-103, 1985. – reference: 10) 財津昭憲: 高頻度極短時間呼気遮断による呼気振動型呼気終末圧陽圧人工呼吸. 呼吸 3 : 794-801, 1984. – reference: 12) 篠崎正博, 山下徳次郎, 杉山和英, 他: 重症呼吸不全患者におけるSuperimposed High Frequency Jet Ventilationの効果. ICUとCCU 6 : 975-981, 1982. – reference: 29) 鏡勲: 安本和正: Inversed ratio ventirationが開心術後のガス交換能に及ぼす影響. 人工呼吸, 投稿中 – reference: 2) 安本和正, 稲田豊: 高齢者に対する術中呼吸管理. 麻酔 35 : 91-98, 1986. – reference: 8) Wright, K., Iyrene, R. K., Truog, W. E., et al.: Ventilation by high frequency oscillation in rabbits with oleic acid lung disease. J. Appl. Physiol. 50 : 1056-1060, 1981. – reference: 13) 宮野英範, 中川隆, 青地修, 他: 累積高頻度ジェット換気法. ICUとCCU 11 : 967-974, 1987. – reference: 7) Kuwasako, Y. and Yasumoto, K.: The Comparison of the conventional vertilation and HFJV on respiratory failure. In Proceedings of the 3rd WPCCM Congress, p. 119, 1985. – reference: 25) 安本和正: 術後の栄養管理と肺機能. 人工呼吸 5 : 69-73, 1988. – reference: 18) Schuster, D. P., Snyder, J. V. and Klain, M.: Comparison of venous admixture during high-frequency ventilation and conventional ventilation in oleic acid induced pulmonary edema in dogs. Anesth. Analg. 61 : 735-740, 1982. – reference: 5) 安本和正, 稲田登: Servo HFV unit使用時ジェット振動のタイプが換気力学に及ぼす影響について. 麻酔 34 : 173-179, 1985. – reference: 27) Stiehm, E. R.: Humoral immunity in malnutrition. Fed. Proc. 39 : 3093-3097, 1980. – reference: 9) 太田保世, 笹本浩: 振動呼吸法における血液ガス異常の改善. 厚生省特定疾患呼吸不全調査研究班, 昭和53年度研究業績: 1-5, 1979. – reference: 28) Gross, I.: Natritional and hormonal influences on lung phospholipid metabolism. Fed. Proc. 36 : 2665-2669, 1977. – reference: 14) 安本和正: 新しい呼吸法I, 高頻度換気: 特に振動重畳換気法について. エレクトロニクスの臨床 49 : 19-26, 1984. – reference: 21) Fredberg, J. J.: Augmented difusion in the airways can support pulmonary gas exchange. J. Appl. Physiol. 49 : 232-238, 1980. – reference: 30) Smith, D.W., Frankel, L.R., Ariagno, R. L., et al.: Dissociation of mean airway pressure and lung volume during high-frequency oscillatory ventilation. Crit. Care Med. 16 : 531-535, 1988. – reference: 19) Thompson, W. K., Marchak, B. E., Froese, A. B., et al.: High-frequency oscillation compared with standard ventilation in pulmonary injury model. J. Appl. Physvol. 52 : 543-548, 1982. – reference: 22) Haselton, F. R, and Sherer, P. W.: Bronchial bifurcations and respiratory mass transport. Science 208 : 69-71, 1980. – reference: 4) 安本和正: 各種oscillation重畳による換気動態の変動. 人工呼吸 1 : 54-58, 1984. – reference: 23) Lefer, J.: Circulating currents during high frequency ventilation. Fed. Proc. 39 : 576, 1980. – reference: 3) 佐藤俊男, 勝屋弘忠: 急性呼吸不全に対するHFV重畳法. ICUとCCU 10 : 1081-1083, 1986. – reference: 26) Arora, N. S. and Rochester, D. F.: Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am. Rev. Respir. Dis. 126 : 5-8, 1982. – reference: 1) 安本和正: 高頻度換気. 医学のあゆみ 129 : 1212, 1984. |
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| SubjectTerms | gas exchange high-frequency ventilation oscillation superimpose ガス交換 人工呼吸 振動 重畳型 高頻度換気 |
| Title | EFFECTS OF SUPERIMPOSED JET OSCILLATION ON FOUR INJURED LUNGS IN DOGS |
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