Studies on the Effects of Various types of Collapse Therapy and Pulmonary Resection upon Cardio-pulmonary Function in Patients with Pulmonary Tuberculosis. (5) Thoracoplasty

Abstract

Thoracoplasty is now performed not so frequently as before on account of the popularity of pulmonary resection, but it is still performed widely for the patients with far advanced pulmonary lesions. Therefore there are a number of studies on its effect on the pulmonary function, and detailed studies with spirometry, bronchospirometry and blood gas analysis etc. have been reported about it. On the other hand there are few reports on the pulmonary circulation, and I can not find in litrature comprehansive studies in which venous catheterization and pulmonary function tests are performed simultaneously. This paper reports the present author's results concerning these points.Methods : The methods used for the venous catheterization etc. were similar to those in the first report of the present series. The subjects were 13 patients under thoracoplasty (Group I), and 3 patients under both thoracoplasty and other types of collapse therapy (Group II). Group I was then divided into 3 sub-groups according to the degree of collapse. Namely, the patients with slight lung-collapse formed group a, those with moderate collapse group b, and those with high collapse group c.Results : (1) Group 1 : The decrease in VC was fairly marked, but the decrease in MBC remained relatively slight, and neither of them showed any correlation with the degree of collapse. Minute ventilation tended to increase, especially in group c. Alveolar ventilation was normal, and no correlation was found with the degree of collapse. Alveolar ventilation ratio was the more decreased, the higher the degree of collapse. And the latter showed roughly a positive correlation with % VC.Arterial O2 saturation dropped in general, especially in group c. While arterial CO2 content was normal. Arterial O2 tension dropped markedly, and A-a O2 tension gradient showed a great increase simultaneously, there being a negative correlation between them. Upon each one patient out of the three groups muscular exercise was imposed, and after that arterial O2 saturation was elevated in all of the three.Cardiac index was normal in average, showing a wide range of variety case by case. And there was not found any correlation between the degree of collapse and the change in cardiac index. However, the increase or decrease in cardiac index was correlated with the change in O2 consumption and in patients with decreased cardiac output there was found an increase in vascular resistance and in arterio-venous O2 difference. In three patients muscular exercise was imposed, and cardiac index increased.Right auricular pressure was normal in average, but in a few patients it was found to be clearly elevated or lowered. Right ventricular pressure was normal in general. Pulmonary arterial pressure tended to rise both in diastole and in mean. Its correlation was not found with factors concerning the elevation of pulmonary arterial pressure reported in the previous paper, while it showed only some tendency of correlation with the increase in % VC. Among 3 patients with moscular exercise, the elevation of pulmonary arterial pressure was the most signficant in the patient who gave a remarkable increase in the cardiac output after exercise. Two patients of the three showing a clear elevation of wedge pressure belonged to group c.Vascular resistance was increased remarkably both in pulmonary arteriolar and in pulmonary vascular and the increase in the former was remarkable in patients with far advanced lesions in the non-collapsed lung. The work of right ventricle against pressure was normal.In the most patients with low arterial O2 tension there was found a flat T wave electrocardiographically.(II) Comparison of the results before and after thoracoplasty in the same patients : The decrease in VC was slight. [the rest omitted]