Japanese
Title左心および右心機能に及ぼすPEEPの影響
Subtitle原著
Authors谷知久*
Authors(kana)
Organization*岐阜大学医学部麻酔学教室
Journal循環制御
Volume10
Number2
Page275-287
Year/Month1989/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」雑種成犬を正常群と脱水群に分け, それぞれの左右心機能に及ぼすPEEPの影響, 及び正常群と脱水群との比較について, ラピッドレスポンススワン・ガンツカテーテルを用いて検討した. 脱水により心拍出量, 両室駆出率, 両室拡張終期容量の有意の減少がみられたが, 両室拡張終期圧には有意の変化がみられなかったため, 前負荷の評価として熱希釈法による駆出率及び容量の測定は, 圧測定よりも鋭敏であると考えられた. PEEPによる右室駆出率の低下は後負荷の増大が原因と考えられた. 一方, 左室に関してはPEEP 10cmH2O以上では, 心室中隔の偏位による左室腔の解剖学的変化が起こると考えられた. また脱水状態がみられる場合には低いPEEPでも著明な血圧の低下が見られるので, 十分注意しながら呼吸管理をする必要がある.
Practice基礎医学・関連科学
KeywordsPEEP, cardic function, ejection fraction, hypovolemia
English
TitleThe Effect of Positive End-Expiratory Pressure on Right and Left Ventricular Function
Subtitle
AuthorsTomohisa Tani
Authors(kana)
OrganizationDepartment of Anesthesiology Gifu University School of Medicine
JournalCirculation Control
Volume10
Number2
Page275-287
Year/Month1989/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractThe effect of positive end-expiratory pressure (PEEP) on right and left ventricular function was Studied in six mongrel dogs and nine hypovolemic mongrel degs. Hypovolemia was induced by the administration of Mannitol and Furosemide. PEEP was increased from 0 to 20 cmH2O in 5 cmH2O increments. Following the addition of PEEP, in both groups of dogs, there was a decrease in cardiac output (CO), stroke volume (SV), right ventricular ejection fraction (RVEF), left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) ; and an increase in mean pulmonary arterial pressure (MPAP), pulmonary vascular resistance (PVR) and right ventricular end diastolic volume (RVEDV). In the hypovolemic group of dogs there was also a decrease in mean arterial pressure (MAP) and RVEDV. From these results, the following conclusions are drawn. 1. Ejection fraction measurements provide a more sensitive measurement for evadluating the hypovolemic state than do ventricular end diastolic pressure measurements. 2. Induced hypovolemia by the administration of Mannitol and Furosemide impairs cardiac function. 3. The decrease in RVEF with PEEP is partialy due to the increase in PVR. The decrease in LVEF with PEEP values above 10 cmH2O is probably due to geometric changes of the left ventricle caused by displasement of ventricular septum induced by the elevation of right ventricular end diastolic pressure (RVEDP). 4. The decrease in CO associated with PEEP is caused not only by the impairment of venous return, but also by the impairment of cardiac function. 5. At low PEEP values, hemodynamic changes were more severe in the hypovolemic group than the normovolemic group. However, at high PEEP values the changes were similar for both groups.
PracticeBasic medicine
KeywordsPEEP, cardic function, ejection fraction, hypovolemia

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