病態における心,ならびに,末梢循環力学的数値と,その治療による変化
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概要
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By means of newly improved Wezler's (1948) and Blumberger-Holldack's methods used simultaneously, cardio-vascular dynamical values with respect to the following items were observed : a. the effects of the treatment of various cardio-vascular diseases b. the influence of the anoxic test c. the consequence of the administration of hypotensive drugs and vasoactive substances including norepinephrine. 1. Polygram was obtained as follows, Carotid and femoral arterial pulse waves, E.C.G. Cusually by the second lead), and phonocardiogram were registered on the oscillogram at the same time; the latter was recorded with the crystal microphone of which the characteristics corresponds to that of Luisada's stethoscopic microphone. 2. The normal range of cardiac dynamical values gained in thirty normal cases show that UFZ ("Umformungszeit") is 34〜75 σ, DAZ ("Druckanstiegszeit") 13〜63 σ, ASZ ("Anspannungszeit" 84〜111 σ, ATZ ("Austreibungszeit.") 253〜314 σ, ATZ/ASZ 2.4〜3.6 respectively. 3. According to the recompensation in the cases suffered from mitral valvular diseases, prolonged ASZ and diminished ATZ tend to become normal. In the markedly decompensated aortic regurgitation, ASZ is shorten, ATZ is delayed or remains unchanged. However as the recompensation is advanced, decreased ASZ and increased ATZ/ASZ are apt to return to the normal limits. 4. Among Keith-Wagener's first and second type of essential hypertension nearly one half of cases shows the prolongation of DAZ and ASZ. In the more severe cases, besides the increase in number of the patients with delayed ASZ there are also found the striking augmentation of the cases with prolonged UFZ, however the patients with delayed ATZ are observed only in a minority of them. In the resistance hypertension ("Widerstandshochdruck"), according to the progress of the degree in Keith-Wagener's classification the patients with delayed DAZ, UFZ and ASZ increase in number. The similar tendency can be recognized also in the elasticity hypertension ("Elastizitatshochdruck"). In the majority of minute volume hypertension ("Minutenvolumenhockdruck") there is observed the increase in UFZ, ASZ, and ATZ. The patients with abnormal electrocardiographic or urinary findings have tendency to increase in UFZ, DAZ and ASZ, while those who lack in such symptoms are apt to show the prolongation of ATZ markedly. In the cases classified with the height of blood pressure there exists no uniform mode of changed upon the cardiac dynamical values, however in proportion to the elevated diastolic piessure, UFZ, DAZ and ASZ tend to be lengthend. 5. The intravenous injection of nor-epinephrine shows the cardiac dynamics in the sense of the pressure reaction ("Druckreaktion"). 1-Hydrazinophthalazine exhibits the vascular dynamics meant by "Entspannungstypus (Duesberg et al)", whereas in the cardiac dynamics it denotes diminution in all Blumberger-Holldack's values. C_5 does not display any variation of vascular dynamics in the definite direction, but it develops frequently a tendency to show the pressure reaction cardio-dynamically. Reserpine (Serpasil "Ciba") often exhibits the vascular dynamics in the sense of "Entspannungstypus", whereas it does not denote any conclusive mode of the action cardio-dynamically. Among the hypertensive patients in whom, the chronic application of depressant drugs does not bring the favourable effect clinically, despite of some significant changes in the peripheral dynamics, there can not be recognized any remarkable variation in the cardiac dynamics. Conversely, in the patients with the favourable effects, the pressure-, or the volume-loads disapper cardio-dynamically. 6. In the renal hypertension DAZ and ASZ are prolonged distinctly, moreover, in all cases except for chronic nephritis, ATZ is markedly reduced. These features return to the normal pattern as the recompensation is advanced. 7. One of two patients suffered from chronic cor pulmona'le shows the vascular dynamics meant by "Entspannungstypus", while another case exhibits that in the sense of "Anspannungstypus (Duesbery et al)"; cardio-dynamically both patients denote the pressure response. These changes return to normal range, although to the small extent, by means of the adminstration of digitalis, and aminophylline preparates. 8. The most cases with myocardial infarction or hypertensive cardiac disease have a slight tendency to show the pressure response, while the patients suffered from angina pectoris or coronary sclerosis do hardly develop such a fluctuation. 9. Amyl-nitrite affects "entspanned" vasculo-dynamically, whereas it displays "Druckreaktion" cardio-dynamically. Aminophylline or Lacarnol "forte" does not show any fixed direction of the variations cardio-vasculo-dynamically; their mode of effects differ largely from the underlying disorders. Anoxic test is apt to exhibit "Entspannungsreaktion" vasculo-dynamically, however it does not denote any definte mode of the cardio-dynamical variations. 10. In the cases suffered from severe myocardial insufficiency, UFZ DAZ and ASZ are all prolonged, ATZ remains normal or becomes subnormal. Stroke- or minutevolum tends to be reduced.
- 千葉大学の論文
- 1958-05-28