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人工呼吸管理症例における呼気一酸化窒素測定方法に関する検討
https://ycu.repo.nii.ac.jp/records/887
https://ycu.repo.nii.ac.jp/records/887ad53cafe-e9b1-4ba1-940a-f07392c7a96e
名前 / ファイル | ライセンス | アクション |
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KJ00004192654.pdf (651.1 kB)
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Item type | [ELS]紀要論文 / Departmental Bulletin Paper(1) | |||||
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公開日 | 2017-04-21 | |||||
タイトル | ||||||
タイトル | 人工呼吸管理症例における呼気一酸化窒素測定方法に関する検討 | |||||
タイトル | ||||||
言語 | en | |||||
タイトル | ANALYSIS OF SINGLE BREATH MEASUREMENT TO OBTAIN EXHALED NITRIC OXIDE CURVES IN VENTILATED PATIENTS | |||||
言語 | ||||||
言語 | jpn | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 一酸化窒素 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 呼気一酸化窒素 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 人工呼吸 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 呼気流速 | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | nitric oxide | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | exhaled nitric oxide | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | mechanical ventilation | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | expiratory flow rate | |||||
資源タイプ | ||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||
資源タイプ | departmental bulletin paper | |||||
雑誌書誌ID | ||||||
収録物識別子タイプ | NCID | |||||
収録物識別子 | AN00246369 | |||||
著者 |
中村, 京太
× 中村, 京太× NAKAMURA, Kyota |
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著者所属(日) | ||||||
値 | 横浜市立大学大学院医学研究科生体制御・麻酔科学 | |||||
著者所属(英) | ||||||
言語 | en | |||||
値 | Department of Anesthesiology and Critical Care Medicine Yokohama City University Graduate School of Medicine | |||||
記事種別(日) | ||||||
内容記述タイプ | Other | |||||
内容記述 | 原著 | |||||
記事種別(英) | ||||||
内容記述タイプ | Other | |||||
内容記述 | ORIGINAL ARTICLE | |||||
抄録(日) | ||||||
内容記述タイプ | Other | |||||
内容記述 | 一酸化窒素(nitric oxide:NO)はガス状メディエータとして,生体内反応に関与すると考えられ,特に炎症反応の制御に重要な役割を呈していることが明らかにされてきた.気道内で産生されるNOは呼気中に検:出されるため,その濃度を測定することは気道内での炎症の指標になりうる.特に気管支喘息の重症度評価では,すでに臨床使用されている.また,急性肺障害の早期診断に有効であるとする報告がされ,周術期,集中治療領域で応用できる可能性が示唆されている.呼気NO測定方法の要点は呼気流速を一定に保っことにあるが,従来の人工呼吸管理下で,呼気流速を一定にすることは難しく,確立された測定方法は存在しない.本研究の目的は,人工呼吸管理下での呼気NOの産生部位が推定できる測定法を確立することとし,その方法として人工呼吸回路に気道抵抗を加え,breath-holdingを併用した換気モードで測定することにより炎症部位診断を可能とする波形が得られるとの仮説を立て,研究を行った.全身麻酔下に手術を予定された5症例を対象とした.それぞれの症例で通常の換気モードと気道抵抗を加えbreath-holdingを併用した換気モードで測定を行った.結果,人工呼吸回路に気管チューブによる気道抵抗を加えて呼気流速の変化を少なくし,breath-holdingを併用した換気モードで測定することにより,炎症部位診断を可能とする波形が得ることができた.本方法は,呼気NO濃度測定から産生部位診断を含めたNO産生量を推定可能にし,single breathでの測定として有用であると考えられた.今後,連続モニタに応用可能な方法の開発と病態による波形や産生量の変化に関しての研究が必要であると考える. | |||||
抄録(英) | ||||||
内容記述タイプ | Other | |||||
内容記述 | Exhaled nitric oxide is a marker of airway inflammation and lung injury. Exhaled NO values vary considerably with exhalation flow rate. Therefore, standardization of exhalation flow is critical for obtaining reproducible measurements. In ventilated patients, it is difficult to standardize the exhalation flow rate, and a detailed method of exhaled NO measurements has not yet been found. In a previous study, in natural airway patients, characterized exhaled NO curves were obtained by a single breath maneuver with breath-holding and constant flow exhalation. The exhaled NO curves are divided into a dead space (phase 1), a mixture of airway and alveolar gas (phase 2), and the alveolar plateau (phase 3). The aim of this study was to develop a technique for obtaining characterized exhaled NO curves in ventilated patients. Five patients that underwent planned operations under general anesthesia were enrolled. During general anesthesia, exhaled NO was continuously measured under normal ventilation (VT = l0ml/kg, f =10bpm, I : E =1 : 2, Tpause/Ti = 10%) and breath-holding ventilation (VT =15ml/kg, f = 4bpm, I : E = 2 : 1, Tpause/Ti = 50%) with an expiratory resistance tube to produce the constant flow exhalation. During normal ventilation, expiratory flow rate decelerated and exhaled NO curves showed a small peak (5.8 ± 2.7ppb) in phase 1 and 2 (dead space and airway), and then increased slowly (6.0 ± 4.2ppb) in phase 3 (alveolar gas). In constant flow exhaled ventilation, exhaled NO curves showed a large peak (20.8 ± 9.9 ppb) in phase 2 and decreased gradually to a constant plateau (6.0 ± 2.7ppb) in phase 3. Airway gas was clearly distinguishable from alveolar gas (p = 0.023). We used an expiratory resistance to produce constant expiratory flow in the ventilated patients. Breath-holding ventilation with expiratory resistance showed exhaled NO curves comparable to those of previous studies. This method during mechanical ventilation can be useful in differentiating airway and alveolar inflammation. | |||||
書誌情報 |
横濱醫學 en : The Yokohama medical journal 巻 56, 号 1, p. 17-22, 発行日 2005-01-31 |
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表示順 | ||||||
内容記述タイプ | Other | |||||
内容記述 | 6 | |||||
アクセション番号 | ||||||
内容記述タイプ | Other | |||||
内容記述 | KJ00004192654 | |||||
ISSN | ||||||
収録物識別子タイプ | ISSN | |||||
収録物識別子 | 03727726 |