Studies on the Effects of Various Types of Collapse Therapy and Pulmonary Resection upon Cardiopulmonary Function in Patients with Pulmonary Tuberculosis (4) Extrapleural Synthetic Resion Plombage

Abstract

Since the extrapleural synthetic resin plombage (hereafter abbreviated as plombage) was proposed by Nagaishi, it has sprad rapidly owing to its merit that it could dispense with the resection of ribs and could evoke the collapse of lesions selectively, thus making its disturbance upon pulmonary function rather slight. But in a little while it became to be scarcely practiced, chiefly according to the untoward postoperative complications. When plombage was adopted, studies on cardiopulmonary function were scarcely performed, and therefore there have been only a few reports on its effects upon cardiopulmonary function. This paper reports the present author's results of venous catheterization etc. on patients operated under plombage.Methods : The methods used for the venous catheterization etc. were similar to those in the first report of the present studies. The subjects were 5 patients under plombage, and one of them was similarly examined before operation.Results : The decrease in VC was pretty remarkable, while the decrease in MBC remained relatively slight. Minute ventilation was increased, but alveolar ventilation was normal, so alveolar ventilation ratio was found to be low. Arterial O2 saturation was normal, but in one of these patients, on whom muscular exercise was imposed, arterial O2 saturation dropped remarkably after exercise.Cardiac index tended to decrease in general, and it was decreased more remarkably in the group with high collapse than with moderate, and there was found statistically a significant difference between the two groups.Concerning pulmonary circulation, right auricular pressure was normal, but in the group with high collapse right ventricular pressure and pulmonary arterial pressure were both remarkably elevated, and the latter showed a significant difference between the two groups. Pulmonary arterial pressure showed a negative and a positive correlation with cardiac index and vascular resistance respectively.Vascular resistance was increased both in pulmonary arteriolar and in pulmonary vascular, and it was more remarkably in the group with high collapse than in the other. There was found a significant difference between the two groups. Work of right ventricle against pressure was normal.Comparing the results of one patient before and after operation, the decrease in VC remained very slight in spite of his high collapse, and arterial O2 saturation was elevated slightly, while both right ventricular pressure and pulmonary arterial pressure were clearly elevated after operation. Cardiac index decreased slightly and pulmonary vascular resistance increased remarkably after operation.Discussion and Conclusion : The decrease of VC in patients under plombage was greater than its decrease in tuberculous patients whose lesions were nearly the same. This may be due to the inevitable collapse of some amount of healthy lung parenchyma and to the pleural thickening complicated by operation. On the other hand the decrease of MBC after this operation was lighter than that of the tuberculous patients with lesions of similar degree. This is considered to be due to the needlessness of the resection of ribs and to the selective collapse of the lesions.Arterial O2 saturation was normal in general, and it was even elevated after operation in one of these patients. This is to be explained by the following facts. First, some amount of venous admixture coming from lesions decreased by the collapse of tuberculous part of the lung. Second, this operation does not injure the ventilation-perfusion relationships in other parts of the lung because the ribs are not resected. Thus any clear pulmonary insufficiency was not found at rest, while in one patient with high collapse arterial O2 saturation dropped remarkably after muscular exercise. This shows the decrease of pulmonary functional reserve, so clinicians must always be careful for it. [the rest omitted]