犬・猫の呼吸器臨床研究会

診療基準研究班の報告(2018.12.5 更新 計8)

「城下幸仁. 犬・猫の呼吸器を診る(1) 呼吸器の基礎と体系、診断の過程. SA Medicine2017;19:63-74.」の内容を検証します。とくに、症状のスコア化、血液ガス分析、検査実施方法の標準化についての文献レビュー

咳の臨床グレーディング


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呼吸困難のスコア化、客観評価法


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運動不耐性のスコア化、客観評価法


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聴診音の機序や疾患との関連


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獣医療における動脈血ガス分析の適用について

一般

Shiroshita Y, Tanaka R, Shibazaki A, et al. Retrospective study of clinical complications occurring after arterial punctures in 111 dogs. Vet Rec 2000;146:16-19.

犬の動脈穿刺111例に対する合併症について

The clinical complications occurring after 111 dogs had undergone arterial punctures were reviewed in relation to the dogs’ breed, bodyweight, age, sex and underlying diseases. Seven of the dogs had moderate to extensive ecchymoses, which were significantly more common in dogs under 3.5 kg in bodyweight and in dogs with disorders of the cardiovascular system.

コメント:7/111例で軽度から広範な皮内出血が生じたが全身状態に影響を与えなかった。この合併症は、体重3.5kg以下、心血管障害を有する犬で有意に生じやすかったが、10-14日で問題なく消失した(犬・猫の呼吸器科 城下-2018.11.28)。


城下幸仁:特集 血液ガス 「血液ガスとは-その理論と重要性」、InfoVets 3(8), 11-16, 2000

コメント:臨床血液ガスについてコンパクトにまとめております(犬・猫の呼吸器科 城下-2018.11.28)。


城下幸仁, 山根義久. 外来患犬に行われた動脈血血液ガス分析176例. 日本獣医学会131回講演要旨集 2001:150.

【目的および方法】小動物臨床において動脈血血液ガス分析はいまだルーチン化されていない。そこで、その臨床応用への有用性を評価するため、過去6年間に外来患犬に行われた全ての動脈血血液ガス分析結果およびその診療記録を調査し、i)正常犬の値、ii)患犬の基礎疾患、iii)各種酸塩基平衡障害の頻度、iv)低酸素血症の頻度、について検討した。動脈血血液ガス分析:大腿動脈を経皮的に穿刺してサンプル採取し、pH、PCO2、PO2、[HCO3-]、およびBase Excessについて、37℃で測定した。血液ガス分析装置にはOPTI 1(AVL)を用いた。

【結果】 総計176例が得られた(体重1.3-29.2kg、年齢0.3-16歳、雄74:雌102、疾患あり150/臨床的に正常26、無麻酔room air下164/酸素吸入下12)。i)無麻酔room air下の正常犬20例の平均値±2SDは、pH 7.406±0.057、PCO2 34.7±7.2 mm Hg、PO2 96.3±16.3 mm Hg、[HCO3-] 21.3±3.8 mmol/L、Base Excess -2.5±3.7 mmol/Lだった。ii) 基礎疾患で多かったのは呼吸器系(40例)、心血管系(25例)、泌尿器系(14例)だった。 iii)疾患犬150例中66例[44.0%]から何らかの酸塩基平衡障害を検出でき、順に、呼吸性アシドーシス26例[17.3%]、代謝性アルカローシス 20例[13.3%]、代謝性アシドーシス13例[8.7%]、呼吸性アルカローシス7例[4.7%]であった。iv) 疾患犬で無麻酔room air下140例中42例[30.1%]から低酸素血症を発見でき、順に、重度(PO2<40)4例[2.9%]、中等度(40-49.9)4例[2.9%] 、軽度(50-59.9)6例[4.3%] 、ごく軽度(60-79.8)28例[20.0%]であった。

【総括】動脈血血液ガス分析は、日常診療でルーチン化すれば種々の疾患犬の酸塩基平衡障害および低酸素血症を的確に診断でき、臨床的に有用である。

コメント:体温補正しない正常値を示しました(犬・猫の呼吸器科 城下-2018.11.28)。


城下幸仁. 血液ガスで肺機能を考える. 第26回動物臨床医学会年次大会プロシーディングno.2 2005:13-17.

コメント:換気血流比不均等について述べています(犬・猫の呼吸器科 城下-2018.11.28)


城下幸仁. 体液異常に挑む(原因の見極めと治療) 血液ガス・酸塩基平衡異常. 動物臨床医学会年次大会プロシーディング 2012;33回:322-326.

コメント:酸塩基平衡の基本的な考え方について述べています(犬・猫の呼吸器科 城下-2018.11.28)。


末梢血静脈血の適応限界

城下幸仁, 山根義久. 犬の末梢静脈血の血液ガス分析値の臨床応用への適応限界について. 動物臨床医学 2004;13:61-65.

犬における末梢静脈血の血液ガス分析値の臨床応用への適応限界を提示するため、連続した61例の循環動態が維持された外来患犬より続けて採取した動脈血と末梢静脈血サンプルを用い、両者の血液ガス分析値を比較した。末梢静脈血は、安静時に横臥で駆血をせず、シリンジ内に空泡を混入せずに採取された。そのサンプルは、動脈血のpH,炭酸ガス分圧(Pco2)、重炭酸塩濃度([HCO3]),塩基過剰(Base Excess、以下B.E.)値とかなりの相関を示したが(R2 = 0.56 – 0.79)、pHで動脈血値より有意に低く、Pco2で有意に高く、Po2で有意に低く、[HCO3]で有意に高い値を示した。B.E.値は動脈血値と有意差なく臨床的にも差がないと考えられた。末梢静脈血のB.E.値は臨床目的に動脈血値と代用可能である。末梢静脈血サンプルの血液ガス分析値は、B.E.を除き、動脈血のおおよその値を推測するにすぎず動脈血値に代用できない。

コメント:末梢静脈血の血液ガスサンプルは、採血時手技に気を払う必要があり、実質利用できるのは外頸静脈のみで、それでも動脈血値に臨床的に代用できる値は Base  Excessのみです(犬・猫の呼吸器科 城下−2018.11.28)。
動脈血化末梢静脈血の評価

Shiroshita Y, Yamane Y. Assessment of arterialization of peripheral venous blood in well-perfused dogs: 2012 ACVIM Forum Abstructs (oral presentation) in New Orleans, LA. J Vet Intern Med 2012;26:822.

循環動態が維持された犬における末梢静脈血の動脈血化の評価

Multiple arterial blood gas samples are essential for monitoring a patient during perioperative and critical care. In small animals, an indwelling arterial cannula is usually used for multiple blood gas sampling, although it may cause massive hematoma from rupture of the artery. In well-perfused humans, blood obtained from a superficial hand vein after heating the hands in hot water for several minutes has been reported as an appropriate substitute for arterial samples for the measurement of pH, PCO2, and lactate. The heated-hand technique is referred to as arterialization. Multiple blood gas samples can be obtained more easily and safely with this technique than with an indwelling arterial cannula. This study aimed to ascertain if arterialized venous blood samples can replace arterial blood gas sampling in well-perfused dogs.

Blood samples from the femoral artery (A), cephalic vein (CV), and saphenous vein (SV) were simultaneously collected from 8 lightly anesthetized dogs under conditions of experimentally induced metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis in each dog. Samples were analyzed for pH, PCO2, PO2, [HCO3−], and base excess for each acid–base status. Metabolic acidosis was induced by continuous infusion of 0.6 M NH4Cl in 5% dextrose, and metabolic alkalosis was induced by administration of 1 M sodium bicarbonate solution. Respiratory acid–base disturbances were induced by mechanical ventilation. The forepaw and hindpaw were continuously heated at 37oC to arterialize CV and SV. Mean arterial pressure was maintained at more than 80 mm Hg. Statistical analysis was performed using MANOVA and linear regression. Bland–Altman plots were used to assess the degree of agreement between the blood gas values of A and arterialized CV or SV. P < 0.05 was considered statistically significant.

pH, [HCO3−], and base excess values in arterialized CV and SV exhibited no significant differences from those in A, high correlations with those in A (coefficient of determination, r2 = 0.93–0.99), and a clinically approximate agreement with those in A, respectively. PO2 values under all acid-base statuses in arterialized CV and SV were significantly lower than those in A (P < 0.01) and not correlated with those in A (r2 = 0.51–0.75), respectively. PCO2 values under metabolic acidosis in arterialized CV and SV were significantly higher than those in A [CV, 38.7 ± 2.6; SV, 37.5 ± 2.6; A, 33.2 ± 3.0 (mean ± SD) mm Hg; P < 0.01]. However, PCO2 in arterialized SV was closely correlated with that in A under both metabolic and respiratory acid–base disturbances (r2 = 0.93 and 0.99, respectively). It also demonstrated clinically acceptable agreement with that in A. In conclusion, arterialized SV blood samples can replace arterial blood gas samples for the measurement of pH, PCO2, [HCO3−], and base excess in well-perfused dogs for clinical purposes.

コメント:循環動態が安定した犬において後肢趾端部を37°に保温した環境下でのサフエナ静脈血サンプルは、動脈血のpH, PCO2, [HCO3−], Base Excess値に臨床的に代用可能である(犬・猫の呼吸器科 城下−2018.11.28)
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X線検査の実施方法の標準化


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透視検査の有用性と標準化


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胸部CT検査の所見と疾患関連について


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呼吸器疾患罹患動物のQOLの定義


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各呼吸器疾患の診断基準と治療法について


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呼吸器診療に関するその他の有用な情報


Branter E, Weisse C, Berent A. Tracheal malformations in Yorkshire Terriors: 2012 ACVIM Forum Abstructs. J Vet Intern Med 2012;26:820-821.

ヨークシャー・テリアにおける気管の限局性「W」型変形

Tracheal collapse is a syndrome describing various forms of functionally narrowed tracheal lumens. Focal tracheal cartilage malformations in Yorkshire Terriers is a previously unclassified manifestation of this syndrome.

The purpose of this study was to describe the clinical signs, diagnostic findings, and short-term outcome following endolumi- nal tracheal stenting for this unique population. Medical records were reviewed of all dogs presenting to the Animal Medical Cen¬ter Interventional Radiology Service with a diagnosis of tracheal malformation. Clinical signs including dyspnea, honking/raspy breathing, and coughing were each serially classified by the owner on a scale of 0-10 (absent to continuous). Outcomes and compli¬cations were reported.

Thirteen dogs, all Yorkshire Terriers, were identified to have non-traditional cartilage malformations of the trachea. Thoracic radiographs found focal collapse at the thoracic inlet in all dogs. All dogs had tracheal stent placement. Tracheoscopy was per- formed in 11/13 dogs and all of these had evidence of shaped tracheal rings. Median pre-stent coughing score was 2 (0-10), post¬-stent was 2 (0-2), median pre-stent honking score was 6.5 (0-10) and post-stent was 0 in all, median pre-stent dyspnea was 5 (2-10) and post-stent was 0 (0-2). Complications occurred in 5/13; 2 stent fractures not requiring intervention and 3 tissue ingrowth (1 resolved with prednisone, 2 required stent placement).

A subset of Yorkshire Terriers exists with a unique form of the tracheal collapse syndrome that can be identified pre-operatively and is treated in similar ways with expected outcomes and complications similar to those reported with other forms tracheal collapse.

Tracheal collapse is a syndrome describing various forms of functionally narrowed tracheal lumens. Focal tracheal cartilage malformations in Yorkshire Terriers is a previously unclassified manifestation of this syndrome.

The purpose of this study was to describe the clinical signs, diagnostic findings, and short-term outcome following endolumi- nal tracheal stenting for this unique population. Medical records were reviewed of all dogs presenting to the Animal Medical Center Interventional Radiology Service with a diagnosis of tracheal malformation. Clinical signs including dyspnea, honking/raspy breathing, and coughing were each serially classified by the owner on a scale of 0-10 (absent to continuous). Outcomes and compli¬cations were reported.

Thirteen dogs, all Yorkshire Terriers, were identified to have non-traditional cartilage malformations of the trachea. Thoracic radiographs found focal collapse at the thoracic inlet in all dogs. All dogs had tracheal stent placement. Tracheoscopy was per- formed in 11/13 dogs and all of these had evidence of shaped tracheal rings. Median pre-stent coughing score was 2 (0-10), post-stent was 2 (0-2), median pre-stent honking score was 6.5 (0-10) and post-stent was 0 in all, median pre-stent dyspnea was 5 (2-10) and post-stent was 0 (0-2). Complications occurred in 5/13; 2 stent fractures not requiring intervention and 3 tissue ingrowth (1 resolved with prednisone, 2 required stent placement).

A subset of Yorkshire Terriers exists with a unique form of the tracheal collapse syndrome that can be identified pre-operatively and is treated in similar ways with expected outcomes and complications similar to those reported with other forms tracheal collapse.

コメント:ヨークシャーテリアには従来の気管虚脱とは異なる気管変形があるようだ。胸郭前口部気管の気管軟骨輪部中央が「W」字型に変形する。13例のヨークシャーテリアでこのタイプの気管狭窄が認められ、飼い主主観のスコア評価にて、咳は比較的軽度、喘鳴や呼吸困難は強かった。気管内ステント設置で対処可能であり、術後の同スコア評価にて咳も喘鳴もほぼ消失した。5/13例で術後合併症あり、2例はステント破損したが処置不要、3例はステント内肉芽組織形成で1例はプレドニゾロンで治癒;2例は再ステント設置した(犬・猫の呼吸器科 城下-2018.12.5)。