Exnerの自律神経緊張検査法と同神経毒のそれにおよぼす影響
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概要
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There are published many reports of the clinical tests of the autonomic nervous tonus. R. Exner (1948). emphasized that oxygen consumption and pulse rate vary with the correlation under the certain tonic states of the autonomic nervous system, moreover that, his method elucidates the autonomic tonicity from these two correlative values with special regards to in-, or decrease of body weight. As a rule, general sympathicotonia or vagotonia appears seldom in the clinical practice. The unsatisfactoriness of the tests hitherto in use depends upon that sympathico-, or parasympathicotropic hypertonus is rather confined to partial somatic symptoms or to functional states of several organs, and that there is usually found the intermingled condition of sympathico-, and parasympathicotonia. In order to investigate the clinical significance of Exner's test, author reexamined Exner's method and observed the influence of several autonomic agents upon the result of his test. Spirometer in the type of Benedict-Roth was used in this experiment as well as Exner's procedure. For the purpose to estimate oxygen consumption, the basal metabolism was determined with Knipping's apparatus. And the respiratory curves were analysed. Before the application of the autonomic agents according to Exner's proposal, the standard form ("Grundform") was determined and thereafter studied the effects of the agents upon the patterns classified by Exner, moreover the fluctuation, of Manoiloff-Kroll reaction and of blood sugar and etc. were simultaneously examined. The types of the spirograms registered in 121 cases were devided into three. The "irregular" spirograms can be more frequently seen in patients suffered from essential and juvenile hypertension, hyperthyroidism, lastly functional cardiac diseases than in normal health. Fifty cases were classified into the standard forms according to Fxner's plan. Normal health and essential hypertension predominate in "stenic normal" form, hyperthyroidism in "sympathicotropic", functional cardiac diseases and hysteria in "asthenic", while "parasympathicotropic" is dominantly observed in various incretoric disorders, except for the "undetermined" form in 5 cases. Some corrections may be necessary as to the relationship pointed out by Exner between pulse rate and oxygen consumption; the reason can be explained as follows. (a) Normal pattern among 50 cases can be found only in one case suffered from pulmonary stenosis companied with palpitation as chief complain. As to pulse rate and basal metabolic value, "sthenic normal" pattern can be observed in 23 cases without tendency to decrease in body weight. So that, to speak strictly, it may not be classified to any group of patterns. (b) The interrelation between pulse and basal metabolic rates is studied on 288 cases. Both values run, in a certain extent, parallel with each other; however such cases are found lesser than those observed by Exner. (c) In organic heart diseases, pulse rates depend upon not only cardiac, but also extracardiac factors, consequently Exner's method can hardly be applied. (d) From the results of the responses to autonomic agents, it may be safe to say that both pulse and basal metabolic rates change almost indifferently from Exner's assumption. Responses to autonomic agents do not show a difinite characteristic correlation to the tonicity determined before the examination. (a) Norepinephrine, Priscol "Ciba", Reserpine (Serpasil "Ciba") and Deserpidine "Ciba" alter scarcely the patterns classified by Exner. (b) Atropine and Ansolysen "Dai Nippon Seiyaku" set up "adynamic" pattern accompanied with tachycardia. (c) Epinephrine elicites "sympathicotropic" type. (d) Chlorpromazine does not show a certain mode of response, nearly among a half of cases, but there occurs the slight decrease in basal metabolism. In hyperthyroidism, tachycardia as well as arrhythmia appear by means of this medication. (e) Mode of variation of either Manoiloff-Kroll's test or blood sugar does not always agree with that of results of Exner's test. So far as the limits above mentioned are considered into the interpretation of Exner's test, his method may be evaluated as one of the indication of the autonomic tonus at the given time-point.
- 千葉大学の論文