片肺換気と低酸素性肺血管収縮
わが国で平成8年から9年にかけての1年間に,胸部外科手術の68%に片肺換気(OLV)が施行され,必須のテクニックとなった.肺分離には72%で左用ダブルルーメンチューブ(DLT)が使用されている.正確なDLTの位置決めが最も重要で,気管支ファイバースコープは必須である.OLV中のチューブ位置ずれによる換気不全が最も多い合併症で,気管損傷,肺水腫など重篤なものも発生する.OLV中の肺膨張の必要性についてはさらに虚血-再灌流肺傷害の観点から検討する必要がある.吸入麻酔薬や血管拡張剤は本質的にはHPVを抑制し,OLV中の低酸素血症の原因となるが,種々の拮抗作用が働くため,低濃度ならば臨床的に問題はない...
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| Published in | 日本臨床麻酔学会誌 Vol. 18; no. 6; pp. 561 - 569 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
1998
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.18.561 |
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| Abstract | わが国で平成8年から9年にかけての1年間に,胸部外科手術の68%に片肺換気(OLV)が施行され,必須のテクニックとなった.肺分離には72%で左用ダブルルーメンチューブ(DLT)が使用されている.正確なDLTの位置決めが最も重要で,気管支ファイバースコープは必須である.OLV中のチューブ位置ずれによる換気不全が最も多い合併症で,気管損傷,肺水腫など重篤なものも発生する.OLV中の肺膨張の必要性についてはさらに虚血-再灌流肺傷害の観点から検討する必要がある.吸入麻酔薬や血管拡張剤は本質的にはHPVを抑制し,OLV中の低酸素血症の原因となるが,種々の拮抗作用が働くため,低濃度ならば臨床的に問題はない.OLVは安全域の狭い麻酔管理法であるので肺生理学と臨床手技を修得し,個々の症例について危険性と利便性を検討のうえ慎重に実施すべきである. |
|---|---|
| AbstractList | わが国で平成8年から9年にかけての1年間に,胸部外科手術の68%に片肺換気(OLV)が施行され,必須のテクニックとなった.肺分離には72%で左用ダブルルーメンチューブ(DLT)が使用されている.正確なDLTの位置決めが最も重要で,気管支ファイバースコープは必須である.OLV中のチューブ位置ずれによる換気不全が最も多い合併症で,気管損傷,肺水腫など重篤なものも発生する.OLV中の肺膨張の必要性についてはさらに虚血-再灌流肺傷害の観点から検討する必要がある.吸入麻酔薬や血管拡張剤は本質的にはHPVを抑制し,OLV中の低酸素血症の原因となるが,種々の拮抗作用が働くため,低濃度ならば臨床的に問題はない.OLVは安全域の狭い麻酔管理法であるので肺生理学と臨床手技を修得し,個々の症例について危険性と利便性を検討のうえ慎重に実施すべきである. |
| Author | 山崎, 和雅 石部, 裕一 堀, 真也 上田, 敬一郎 広沢, 寿一 上田, 真由美 |
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| References | 9) Turnage WS, Lunn JJ: Postpneumonectomy pul-monary edema: A retrospective analysis of as-sociated variables. Chest 103: 1646-1650, 1993 18) Marshall BE, Marshall C: Anesthesia and the pulmonary circulation, Clinical physiology series, vol.7, Effects of anesthesia. Edited by Cavino BG, Fozzard HA, Rehder K, Strichartz G, American physiological society, Bethesda, 1985, 121-136 11) Slinger PD: Perioperative fluid management for thoracic surgery: The puzzle of postpneumo-nectomy pulmonary edima. Journal of Cardiothor-acic and Vascular Anaesthesia 9: 442-451, 1995 5) White GMJ: A new double lumen tube. Br J Anaesth 32: 232-234, 1960 6) Robertshaw FL: Low resistance double-lumen endobronchial tubes. Br J Anaesth 34: 576-579, 1962 20) Ishibe Y, Gui X, Uno H, et al.: Effect of sevoflurane on hypoxic pulmonary vasoconstriction in the per-fused rabbit lung. Anesthesiology 79: 1348-1353, 1993 26) 中村正人:ニフェジピンの低酸素性肺血管収縮に対する影響についての実験的検討.麻酔 36: 168～178, 1987 25) 石部裕一,中村正人,楳田高士ほか:プロスタサイクリン(PGI2)の低酸素性肺血管収縮反応への作用.麻酔 38: 1619～1626, 1989 21) Domino KB, Borowec L, Alexander CM, et al.: Influence of isoflurane on hypoxic pulmonary vasoconstriction in dogs. Anesthesiology 64: 423-429, 1986 22) Benumof JL: Isoflurane anesthesia and arterial oxygenation during one-lung anesthesia. Anesthe-siology 64: 419-422, 1986 17) Domino KB, Wetstein L, Glassor SA, et al.: Influ-ence of mixed venous oxygen tension (PVO2) on blood flow to atelutthin lung. Anesthesiology 59: 428-434, 1983 1) Benumof JL, Alfery DD: Anesthesia for Thoracic Surgery. ANESTHESIA 2nd edition, Volume 2, Edited by Miller RD, Churchill Livingstone, New York, 1986, 1371-1462 19) Marshall BE: Pulmonary blood flow and oxygena-tion, Anesthesia for thoracic procedure. Edited by Marshall BE, Longnecker DE, Fairly HB, Boston, Blackwell Scientific Publications, 1988, 74-118 7) Inomata S, Nishikawa T, Saito S, et al.: "Best" PEEP during one-lung ventilation. Br J Anaesth 78: 754-756, 1997 23) 宇野洋史,石部裕一,楳田高士ほか:イソフルレンの低酸素性肺血管収縮反応抑制作用の検討.麻酔 43: 1288～1296, 1994 15) Voelkel NF: Mechanisms of hypoxic pulmonary circulation. How and where it acts. Am Rev Respir Dis 133: 1186-1195, 1986 13) Waller DA, Keavey P, Woodfine L, et al.: Pulmo-nary endothelial permeability changes after major lung resection. Ann Thorac Surg 61: 1435-1440, 1996 14) Fishman AP: Hypoxia on the pulmonary circula-tion. Circ Res 38: 221-231, 1976 16) 石部裕一:低酸素性肺血管収縮.呼吸 9: 1430～1439, 1990 8) Taguchi H, Yamada K, Matsumoto H: Airway trouble related to the double-lumen endobronchial tube in thoracic surgery. J Anesth 11: 173-178, 1997 3) Crafoord C: On the technique of pneumonectomy in man. Acta Chir Scard 81 (Suppl.) 54: 1-142, 1938 12) Parquin F, Marchal M, Mehiri S, et al.: Post-pneumonectomy pulmonary edema: analysis and risk factors. Eur J Cardiothorac Surg 10: 929-933, 1996 4) Carlens E: Anew flexible double-lumen catheter for bronchospirometry. J Thorac Surg 18: 742-746, 1949 24) Ishibe Y, Shiokawa Y, Umeda T, et al.: The effect of thoracic epidural anesthesia on hypoxic pulmo-nary vasoconstriction in dogs: An analysis of the pressure-flow curve. Anesth Analg 82: 1049-1055, 1996 2) Magill IW: Anaesthetics in thoracic surgery with special reference to lobectomy. Br J Anesth 13: 92-109, 1936 10) Williams EA, Evans TW, Goldsttraw P: Acute lung injury following lung resection: is one lung anaes-thesia to blame? Thorax 51: 114-116, 1996 |
| References_xml | – reference: 25) 石部裕一,中村正人,楳田高士ほか:プロスタサイクリン(PGI2)の低酸素性肺血管収縮反応への作用.麻酔 38: 1619～1626, 1989 – reference: 5) White GMJ: A new double lumen tube. Br J Anaesth 32: 232-234, 1960 – reference: 24) Ishibe Y, Shiokawa Y, Umeda T, et al.: The effect of thoracic epidural anesthesia on hypoxic pulmo-nary vasoconstriction in dogs: An analysis of the pressure-flow curve. Anesth Analg 82: 1049-1055, 1996 – reference: 4) Carlens E: Anew flexible double-lumen catheter for bronchospirometry. J Thorac Surg 18: 742-746, 1949 – reference: 17) Domino KB, Wetstein L, Glassor SA, et al.: Influ-ence of mixed venous oxygen tension (PVO2) on blood flow to atelutthin lung. Anesthesiology 59: 428-434, 1983 – reference: 1) Benumof JL, Alfery DD: Anesthesia for Thoracic Surgery. ANESTHESIA 2nd edition, Volume 2, Edited by Miller RD, Churchill Livingstone, New York, 1986, 1371-1462 – reference: 6) Robertshaw FL: Low resistance double-lumen endobronchial tubes. Br J Anaesth 34: 576-579, 1962 – reference: 7) Inomata S, Nishikawa T, Saito S, et al.: "Best" PEEP during one-lung ventilation. Br J Anaesth 78: 754-756, 1997 – reference: 19) Marshall BE: Pulmonary blood flow and oxygena-tion, Anesthesia for thoracic procedure. Edited by Marshall BE, Longnecker DE, Fairly HB, Boston, Blackwell Scientific Publications, 1988, 74-118 – reference: 21) Domino KB, Borowec L, Alexander CM, et al.: Influence of isoflurane on hypoxic pulmonary vasoconstriction in dogs. Anesthesiology 64: 423-429, 1986 – reference: 15) Voelkel NF: Mechanisms of hypoxic pulmonary circulation. How and where it acts. Am Rev Respir Dis 133: 1186-1195, 1986 – reference: 12) Parquin F, Marchal M, Mehiri S, et al.: Post-pneumonectomy pulmonary edema: analysis and risk factors. Eur J Cardiothorac Surg 10: 929-933, 1996 – reference: 18) Marshall BE, Marshall C: Anesthesia and the pulmonary circulation, Clinical physiology series, vol.7, Effects of anesthesia. Edited by Cavino BG, Fozzard HA, Rehder K, Strichartz G, American physiological society, Bethesda, 1985, 121-136 – reference: 10) Williams EA, Evans TW, Goldsttraw P: Acute lung injury following lung resection: is one lung anaes-thesia to blame? Thorax 51: 114-116, 1996 – reference: 23) 宇野洋史,石部裕一,楳田高士ほか:イソフルレンの低酸素性肺血管収縮反応抑制作用の検討.麻酔 43: 1288～1296, 1994 – reference: 26) 中村正人:ニフェジピンの低酸素性肺血管収縮に対する影響についての実験的検討.麻酔 36: 168～178, 1987 – reference: 16) 石部裕一:低酸素性肺血管収縮.呼吸 9: 1430～1439, 1990 – reference: 13) Waller DA, Keavey P, Woodfine L, et al.: Pulmo-nary endothelial permeability changes after major lung resection. Ann Thorac Surg 61: 1435-1440, 1996 – reference: 11) Slinger PD: Perioperative fluid management for thoracic surgery: The puzzle of postpneumo-nectomy pulmonary edima. Journal of Cardiothor-acic and Vascular Anaesthesia 9: 442-451, 1995 – reference: 20) Ishibe Y, Gui X, Uno H, et al.: Effect of sevoflurane on hypoxic pulmonary vasoconstriction in the per-fused rabbit lung. Anesthesiology 79: 1348-1353, 1993 – reference: 2) Magill IW: Anaesthetics in thoracic surgery with special reference to lobectomy. Br J Anesth 13: 92-109, 1936 – reference: 3) Crafoord C: On the technique of pneumonectomy in man. Acta Chir Scard 81 (Suppl.) 54: 1-142, 1938 – reference: 22) Benumof JL: Isoflurane anesthesia and arterial oxygenation during one-lung anesthesia. Anesthe-siology 64: 419-422, 1986 – reference: 8) Taguchi H, Yamada K, Matsumoto H: Airway trouble related to the double-lumen endobronchial tube in thoracic surgery. J Anesth 11: 173-178, 1997 – reference: 14) Fishman AP: Hypoxia on the pulmonary circula-tion. Circ Res 38: 221-231, 1976 – reference: 9) Turnage WS, Lunn JJ: Postpneumonectomy pul-monary edema: A retrospective analysis of as-sociated variables. Chest 103: 1646-1650, 1993 |
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| Title | 片肺換気と低酸素性肺血管収縮 |
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