期外収縮および心房細動における循環分析について

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Using our own modification of Wezler's newly improved method (1949), the peripheral circulatory dynamics was estimated in 14 cases with premature beat and 15 cases with auricular fibrillatidn. In this observation the cases in which the cardiac systole does not reveal the properly measurable pulse wave were all excluded. Among 42 extrasystoles, 8 were of supraventricular origin, 34 of ventricular, and 13 were bigeminy, 5 interpolated ventricular premature beat. The circulatory analysis was made regarding extrasystole (Es), basic cardiac beat preceding extrasystole (Ns), and basic heart contraction following premature beat (Ns'), and these calculated dynamical values were studied with respect to the variations of coupling and pause of extrasystole. 1. Es/Ns has tendency to correlate to the length of coupling; namely depending upon the duration of coupling, the ratio of cardiac output increases, those of total peripheral resistance and of volume elasticity tend to decrease. 2. As to Ns'/Ns, when the length of pause. is not exceeding 50σ, the ratio of minute volume is under 1.0, those of total peripheral vascular resistance and of diastolic pressure are more than 1.0. And when the duration of pause is over 80σ, the ratio of minute volume is more than 1.0, total peripheral vascular resistance and diastolic pressure are less than 1.0. The ratio of volume elasticity is for the most part within 1.0, regardless of the length of pause. 3. About Es/Ns, and Ns'./Ns, there is the distinct relationship between ratio of cardiac output and that of total peripheral vascular resistance; the more the ratio of minute volume is, the less that of total peripheral vascular resistance, and vice versa. 4. The next basic contraction following the postextrasystolic beat sometimes increases in its cardiac output as compared with other basic heart beats. This feature is particularly distinguished in cases with interpolated ventricular extrasystole.5. The peripheral resistance and the volume elasticity of the premature beat are large beyond expectation. This is due to the various sorts of antagonistic regulation including the pressoreceptoric nerve reflex and the magnitude of vascular tonicity, thus it may be explained as the homeostasis of the peripheral circulation. However from the view point of the cardiac loading, even if of short duration, it may be concluded as waste. The peripheral resistance tends to have more weight than the volume elasticity with respect to socalled "Anspannungsregulation," that is why in extrasystoles the magnitude of volume elasticity does not so much increase in its magnitude as the peripheral resistance. On auricular fibrillation, the circulatory dynamics of the succession of 10 or 20 waves was analyzed. 1. There can be observed a certain correlation between circulatory dynamical data and stroke duration, especially diastolic period. Namely corresponding to the prolongation of diastolic period, output increases in its amount, peripheral resistance and volume elasticity develop a tendency to decrease. Moreover in proportion to the prolongation of diastolic period, systolic pressure is raised, diastolic is lowered. 2. With special reference to standard deviation, the distribution of circulatory data was studied on the succession of 10 or 20 waves of auricular fibrillation; the value of a is large, the contour of wave is capricious. 3. In patients suffered from auricular fibrillation and congestive heart failure, by means of digitalisation circulatory dynamical data tend to approach the normal range paralell to the improvement of cardiac insufficiency. When the succession of changeable waves of auricular fibrillation in/the same individual is analyzed in course of disease, the circulatory data, although of relative value, may enable us to gain a great deal of significant clinical suggestion.
千葉大学の論文

期外収縮および心房細動における循環分析について

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