稀釋法による循環血液量および諸種體液量測定に關する基礎的並びに臨床的研究

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Dilution method is clinically used to measure circulating blood volume and various body fluid spaces. For dilution method some nontoxic and stable substances which uniformly distribute exclusively into one compartment to be measured have to be selected. But practically we have had no such substances as good enough to be expected. Consequently it is most important to find the time when mixing of injected substance is performed and disappearance rate from the space becomes slow and constantly, though it is easy to determine it correctly. By using each single intravenous injection of T 1824 dye, Na^<24>Cl, Thiocyanate, Mannitol and NAAP solution in this study, the author tried to determine the reasonable sampling time and calculation method in human body.The theoretical bases are as folows : (1) Disapperarance coefficient (K)Dilution curves following single intravenous injection of these substances consist of many exponential curves, and it is considered that these curves during short time are approximate to one exponential curve. The equation of exponential curve is C=C_0e^<-Kt> (t : time, C_0 and C : concentration at time o and t, k : disappearance coefficient)When mixing is completed and slow disappearance continues, there should be correlations between disappearance coefficient and factors regulating disappearance. As these factors there are enumerated F/V(<cardiac output>/<space volume>), and excretion rate in the urine, and membrane permeability.(2) Simple method and extrapolation method It is corrected all disappearance quantity from the space by extrapolation method, while it does only excretion in the urine by simple method, measured from one blood sample and excreted quantity in the urine. When we have obtained the equal value between t_1-simple method and t_1-t_2 extrapolation method, there is steady state at t_1 that mixing is completed and disappearance continues only by way of urinary excretion.(3) Comparison of actually measured excretion in the urine to disappearance calculated from disappearance curve.If this ratio is acout 1. 0,it means that mixing is completed and disappearance from the space is nothing but excretion in the urine. If this ratio is less than 1. 0,distribution is incomplete.(4) Ascites, subcutaneous edema and cerebrospinal fluids etc.By comparing concentration in the ascites, subcutaneous edema and cerebrospinal fluids with plasma concentration at the same time, we can find distribution rate of the injected substance.Subjects : Normal group consists of 30 persons with 30 studies, cardiac group 33 patients with 40 studies and miscellaneous group 30 patients with 31 studies.Results : (1) T-1824 : There was positive correlation between disappearance coefficient (K) from 10 minutes to 2 hours and F/V(<cardiac output>/<total bloodvolume>) except for the patients with congestive heart failure in whom we found rather negative correlation. In the normal subjects mixing was completed at 10 minutes after injection, while in the decompensated cardiacs not yet completed. (2) Na^<24> : These was positive correlation between K from 1 to 3 hours andF/V(<cardiac output>/<Na^<24> space>) except for the patients with severe congestive heart failure. Na^<24> space by 1 hour simple method was equal to slightly larger than extrapolated space from 1 to 3 hours. K from 1 to 3 hours was nearly similar to K from 3 to 6 hours in the normal. In the normal Na^<24> space is suitable to be measured by 1 hour simple method or extrapolation method from 1 to 3 or 6 hours. But in the patients with severe congestive heart failure and marked edema or ascites the volume of distribution of Na^<24> was unstable within 3 hours following injection. K from 1 to 3 hours showed higher value than K from 3 to 6 hours. Na^<24> radioactivity in the ascitic fluid reached to plasma level after 3 hours following injection. In these patients extrapolation method of the gently sloping exponential curve after 3 hours following injection is most adequate for measurement of Na^<24> space.(3) Thiocyanate : Thiocyanate space was about similar to Na^<24> space in 1 hour simple method, but larger than Na^<24> space in 3 hours simple method. It seems likely that thiocyanate is distributed into the larger compartment, probably intracellular space, than Na^<24>.(4) Mannitol : These was no significant correlation between K and F/V(<cardiac output>/<Mannitol space>), but close correlation was found between K from 1 to 3 hours and urinary Mannitol excretion rate. The ratios of excreted mannitol in the urine to disappeared mannitol calculated from disappearance curve from 1 to 3 hours were about 1.0 or less in the normal, but the ratios in the patients with marked edema or ascites was very low. In the former Mannitol distribution into some compartment at 1 hour after injection was not always complete, while in the latter very incomplete. Mannitol concentration in the ascitic fluid did not yet rearch to plasma level 3 hours after injection. Mannitol space by 1 hour simple method was less than extrapolation space from 1 to 3 hours, because extrapolation method was unable to correct rapid urinary excretion during the early phases of mixing.(5) NAAP : There was no significiant correlation between K and F/V(<cardiac output>/<NAAP space>) and between K and urinary NAAP excretion rate. The ratios of excreted NAAP in urine to calculated NAAP from disappearance curve from 3 to 6 hours were about 1. 0 or less in most cases. However, they were very low in the patients with marked edema or ascites. NAAP concentration in the ascites did not reach to plasma level 3 hours after injection. NAAP space by 3 hours simple method was less than extrapolated space from 3 to 6 hours, because of the same reason with Mannitol.These normal averages were as follows : [table] Then these spaces in various pathological states were measured.Total exchangeable sodium (TENa) was also calculated.Normal average were as follows : [table] (TENa)-(Extracellular Na^<24> space×plasma Na level)=Intracellular sodium.Assuming intracellular sodium was calculated from this equation, this intracellular sodium was much less in the patients with marked edema or ascites than those in normal state. When edema or ascites was reduced by treatment, this calculated intracellular sodium got increased as before. But expanded extracellular space plus intracellular space may be measured as extracellular space, so that this decreased intracellular sodium may be calculated erroneously. It is most important whether distribution of the substance used to measure extracellular space is insufficient or excessive on the occasion of the measurement of the change of intracellular space by dilution method.
社団法人日本循環器学会の論文
1957-11-20

稀釋法による循環血液量および諸種體液量測定に關する基礎的並びに臨床的研究

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