Studies on the Effects of Various Types of Collapse Therapy and Pulmonary Resection upon Cardiopulmonary Function in Patients with Pulmonary Tuberculosis. (III Pulmonary Resection)

Abstract

It iswell known that pulmonary resection is the most reasonable surgical therapy for pulmonary tuberculosis. Pulmonary resec- tion, however, causes, on the other hand, some decrease of diffusing area and of vascular bed. Accordingly studies on its effects upon the cardiopulmonary function are clinically important.Many authors have reported about its effects on pulmonary function, and their results are roughly unanimous in that the degree of pulmonary insufficiency is proportional to the volume of resected lung parenchyma while it can be remarkably various depending on the post-operative complications even in the group in which the volume of resected parenchyma is the same. Rather few reports, however, were found on the effects of pulmonary resection upon pulmonary circulation, and in these reports the degree of elevation of pulmonary arterial pressure is not proportional to the volume of the resected pulmonary parenchyma. This shows that pulmonary circulation has a large compensatory capacity, and suggests that these are also other important factors for the elevation of pulmonary arterial pressure besides the decrease of vascular bed. Concerning pulmonary resection, detailed studies have not yet been reported on the correlation between pulmonary function and pulmonary circulation and on the physiological adaptation of right ventricle against a load on pulmonary vascular bed. This paper reports the author's results upon these points.Methods The methods used for the venous catheterization etc. were the same as those in the first report of the present studies. The subjects were 10 patients under various kinds of pulmonary resection, and they were examined eleven times. Group I consists of 3 patients under partial resection, group II of 4 patients under lobectomy, group III of 1 patient under lobectomy followed by partial resection (this patient is also included in group II) and group IV of 3 patients under pneumonectomy.Results Lung volume and ventilatory function : The greater the volume of resected pulmonary parenchyma was, the more remarkable was the decrease in VC and MBC. But the former was not always parallel to the degree of the latter. And compared within the same group, the decrease in VC was more remarkable in patients with pleural callosity or with kyphoscoliosis etc. caused by operation. In 2 patients of group IV (No. 240, 241) the elevation of spirogram to the inspiratory level was noted during the measurment of MBC.Minute ventilation, alveolar ventilation and alveolar ventilation ratio : These were normal or only slightly increased in group I and II respectively, and the increase in alveolar ventilation was more remarkable than that of minute ventilation, so that the increase in alveolar ventilation ratio was noted. In group III these were normal. But in spite of the increase in minute ventilation, alveolar ventilation was normal in group IV, and alveolar ventilation ratio stood at lower limit of normal. In general, positive correlation was found between alveolar ventilation ratio and %VC (Fig. 1).Arterial O2 saturation was nearly at lower limit of normal in group I and II, while it was clearly lower than normal in group IV, and the largest decrease was found in group III. At the same time negative correlation was noted between arterial O2 tension and A-a O2 tension gradient. In case %VC decreased under 40% of normal, %VC showed positive correlation with alveolar O2 tension, while negative with arterial CO2 tension (Fig. 3).Pulmonary circulation : Pulmonary blood flow was normal in all groups. Right auricular pressure and right ventricular enddiastolic pressure were clearly elevated in 3 patients. Pulmonary arterial pressure was elevated evidently in some patients in group I, while it was normal in one patient in graup IV. [the rest omitted]