静脈圧ならびに右心内圧にかんする臨床的研究
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概要
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The peripheral venous pressure (p. v. pr.) was estimated according to Burch's method, the right auricular pressure (central v. pr.), to Cournand's in health and disease. The cases in this observation were confined to those who were suffering from cardiac failure due to various causes, i.e., valvular disorders, myocardial diseases and so on. Firstly venous pressure, peripheral and central, of cardiac patients were determined. at quiet rest, then their fluctuations during treatment, especially, digitalis medication was examined. "Digicorin" of which effects were discussed in this paper is the product manufactured from the Y-number onward. In several cases, the venous pressure before and after application of sympatheticomimetic ammines was also observed. The influence of three kinds of somatic loading upon venous pressure was investigated with aim to elucidate the role of augmented venous return. 1. With respect to its simplicity in performance and its sensitiveness to pressure change, Burch's phlebomanometer is superior to Mobitz's original method or its modification, for clinical purpose. The membrane manometer which was adopted in this observation can be said to be the most excellent among those ever presented. The estimation of right intracardiac pressure by membrane manometry with use of cardiac catheter,・however, has some limitation which is inevitable on cardiac catheterization, so that there remains something to be improved by further studies. 2. In health, there can be seen almost constant difference between p. v. pr. in V. mediana cubiti and diastolic pressure in right auricle or right ventricle, whereas in cardiac insufficiency, venous pressures were raised both peripherally and centrally, and moreover their pressure difference got nearer to zero. In cor pulmonale chronica, so far as there occurs no decompensation, except for the elevated systolic pressure of right ventricle, the other pressures remain frequently within normal range. The pressure determined in V. mediana cubiti suggests, to a certain extent, the state of both right auricular and right ventricular diastolic pressure with the exception of cases with venous compression or obstruction, for example, due to neoplasma. 3. Digicorin as well as other sorts of digitalis preparates, i.e. Uavanin "Takeda", Digoxine "Wellcome" etc. lowers the venous pressure rapidly not only in cases with decompensated valvular disorders or hypertensive cardiac disease, but also in those who are suffering from emphysematous or anemic heart and so on. Although this action mode can be of course explained as the secondary results of the improved cardiac force, yet there are possible to exist some reasons which are suggestive of the more direct effect of digitalis on venous pressure. The elevation of venous pressure due to epinephrine injection has resulted largely from the venous constriction, so that it is of some different nature from that being seen in cardiac insufficiency. The venous pressure in cardiac insufficiency is more apt to be raised by norepinephrine injection than that of normal. 4. The degree of elevation of venous pressure in cardiac insufficiency does not always coincide with the extent of cardiac insufficiency, despite a few exceptions. Therefore the height of venous pressure at quiet rest does not necessarily indicate the severity of disturbed cardiac function nor course and prognosis of cardiac insufficiency. 5. In order to augment venous return, three kinds of somatic loading tests were taken. Among them the effect of the ligature of lower extremities is not distinct, while the elevation of lower extremities and the abdominal compression bring the marked reactions. The estimation of recovery times in these tests is proved significant as well as that of pressure change itself. The reaction of right auricular pressure due to loadings coincides almost with that of the height of p. v. pr. and of the length of recovery time observed peripherally, so that the reactivity of right auricular pressure can be roughly implied from that p. v. pr. In health the fluctuation due to these tests is considerably marked, and the recovery time is short, whereas in congestive cardiac failure the fluctuation is further remarkable and the recovery time is more prolonged. The degree of reactions agrees approximately with tha of clinical symptoms, but is not always parael with the venous pressure at quiet rest. In apparently compensated group, on the contrary to the completely compensated, both pressure change and recovery time react more distinct than those of health. By the medication of digitalis preparates the reactions against these tests can be normalized, mostly pararell with both descending of p. v. pr. at quiet rest and improvement of clinical symptoms. However during digitalis medication there are observed some cases of which venous pressures at quiet rest become entirely normal, but nevertheless the reactions against these tests are still very marked. It is worthwhile taking notice that among such cases the recidive ofcardiac decompensation can be observed much frequently in their further courses.
- 千葉大学の論文
- 1957-01-28