| Japanese |
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| Title | 開心術後の肺水腫-その頻度と成因について- |
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| Subtitle | 特別発言 特集 誌上シンポジウム/肺水腫 |
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| Authors | 公文啓二*, 田中一彦*, 内藤泰顕**, 藤田毅** |
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| Authors(kana) | |
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| Organization | *国立循環器病センターICU, **国立循環器病センター心臓外科 |
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| Journal | 循環制御 |
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| Volume | 5 |
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| Number | 2 |
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| Page | 184-189 |
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| Year/Month | 1984/ |
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| Article | 報告 |
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| Publisher | 日本循環制御研究会 |
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| Abstract | 「要約」1979年1月から1983年12月まで国立循環器病センターICUで経験した開心術後肺水腫59例を対象にその頻度・成因について検討した. 発生頻度は1979年は6.8%であったが最近の2年間では1.5%以内に改善し, 全体では2.8%であった. 成因は血行力学型(DE), 透過性型(PE), 混合型(CE)に分類され, DEは61%(死亡率38.9%), PEは25.4%(73.3%), CEは13.6%(87.5%)を占めた. DEの基礎疾患は虚血性心疾患(IHD)や急性弁膜症が, PEではPHを伴う後天性弁膜疾患(AVDPH)が大多数であった. この相異は, AVD-PHの肺毛細管壁の透過率の低下が術後急性期のDE発症に抑制的に作用するが, 呼吸・循環管理の長期化に伴う敗血症やDICの併発がPEの原因となることから生ずると考えられる. IHDに頻用する静注用ニトログリセリン(NTG)が肺水腫を誘発あるいは増悪する可能性が示唆された. 最近の発症頻度の改善に, NTG投与量の減量とDICの予防・治療の向上の寄与は大であると思われた. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Lung edema following open heart surgery. The incidence and geneses |
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| Subtitle | |
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| Authors | Kumon K*, Tanaka K*, Naito Y**, Fujita T** |
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| Authors(kana) | |
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| Organization | *ICU, National Cardiovascular Center, **Cardiovascular Surgery, National Cardiovascular Center |
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| Journal | Circulation Control |
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| Volume | 5 |
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| Number | 2 |
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| Page | 184-189 |
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| Year/Month | 1984/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | The etiology of lung edema (LE) following open heart surgery was studied on 59 patients who developed LE during the period from 19 79 to 1983. The incidence decreased from 6.8% in 1979 to 1.4 and 1.3% respectively in recent two years, 2.8% in total. These LE were divided into three from the geneses, where dynamic (DE), permeability (PE) and combination edema (CE). The proportion was 61% in DE with a mortality of 38.9%, 25.4% in PE with 73.3% and 13.6% in CE with 87.5%. The majority of basic disease was ischemic heart disease (IHD) in DE and acquired valvular disease with pulmonary hypertension (AVD-PH) in PE. As to the reason for the difference, it was speculated that the sclerotic pulmonary capillary wall (PCW) of AVD-PH might diminishe fluid filtration at PCW to protect the development of DE in LOS, while PCW of IHC were relatively normal. However, sepsis and DIC, developed under prolonged LOS in patients with AVD-PH, increased pulmonary permeability to cause PE. Large doses of intravenous nitroglycerin (NTG) was suspected to accelerate LE. |
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| Practice | Basic medicine |
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| Keywords | Heart surgery, Lung edema, Pulmonary hypertension, Nitroglycerin, DIC |
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