慢性肺疾患に於ける右心機能 : 運動負荷による心送血量と肘静脈圧の変化を中心として

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Pulmonary hypertension, from prolonged pulmonary disease, results in pressure load on the right side of the heart, developing dilatation of the right ventricle and finally progressing to right sided heart failure. Simultaneous mesurement of venous pressure (VP) and cardiac output (CO) with a method which was originally proposed by Hirakawa, was carried out, with some modification, to investigate the progress of the chronic pulmonary disease (CPD) to cor pulmonale. The change of the cardiac index (ΔCI) and that of the venous pressure (ΔVP) with exercise, i.e. "cardio-venous response" were studied in the patients of CPD and of cardiac disease without pulmonary disease. Pulmonary function study and blood gas analysis were performed on these patients to discover its relationship to the cardiac function, as estimated from "cardio-venous response" to exercise. Methods: The subjects were 51 patients of CPD, and 13 patients of cardiac disease. Patients were left quietly on the bed in the supine position for 1 hour. After the blood volume determination,to record the CO, the radiocardiograph (RCG) detector was plased on the anterior chest at the 4th intercostal spase, left sternal border. VP was obtained with a saline manometer, by modified Moritz-Tabora's method, in the cubital vein. With reference to RCG, radio-isotope serum albumin, ^<131>I(RISA), 20 μCi, was injected intravenously and flushed immediately with 10 ml of 5% glucose to get complete and instantaneous injection into the cubital vein on the other side of the arm when the VP became stable. The distribution equilibrium count was recorded at the end of 7 minutes after the shot, keeping the detector at the same place. CO was calculated as follows. CO = (E/A) X blood volume where E: the equilibrium count rate (mm). A: the integrated area under the time-activity curve. Heart rate was monitored by electrocardiogram during examination. Flexion- extension exercise of the lower extremities was then started and continued for 4 minutes at a rate of 36 times a minute, avoiding straining as much as possible. -During that time, CO and VP were measured when the VP reached a relatively stable state. Parameters, including arterial blood gass analysis-pH, P_<CO_2>, P_<O_2>, O_2 Saturation, % vital capacity, and forced expiratory volume in 1 secound (FEV_<1.0 sec.>), were determined on the same day of studies on circulatory dynamics or on the next day, both at rest and during exercise, in the situation.
社団法人日本循環器学会の論文
1976-06-20

著者

竹中茂樹
岐阜大学第二内科学教室

慢性肺疾患に於ける右心機能 : 運動負荷による心送血量と肘静脈圧の変化を中心として

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