心房細動における静脈波の種々相,ならびに,その血行力学的観察
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概要
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The venous pulse waves were recorded by means of the photoelectric sphygmomanometer of Altmann's type, simultaneously in combination with electrocardio-, phonocardiograms, carotid, femoral arterial pulse waves and respiratory curve. By all these accounts, according to Wezler's and Blumberger-Holldack's methods, somewhat modified by our collaborators, the cardio-vascular dynamics was studied, with special reference to Weber's classification of the venous pulse waves. Tn this paper, the arrhythmia due to auricular fibrillation or flutter was taken up as the main problem, because owing to astonishing rapidity with which the influence of the primary heart reaction upon the peripheral circulation is significantly affected by the secondary and the tertiary reactions (Wiggers), it is very difficult clinically ascertain the facts determined in animal experiments or perfussion preparates. In the auricular fibrillation or flutter without valvular disorders, there exists hardly the other factors effective upon the primary heart reaction than the filling time. Our collaborators Yokota (1956), Kinoshita (1957) have agreed with Blumberger (1956) regarding this point, although they worked from independent standpoint. d_G-I, d_G-Y and various types of venous pulse waves according to Weber's classification were studied fourteen times in 7 cases with mitral stenoinsufficiency, 2 with combined valvular diseases, i. e., about 301 venous pulse waves in total. d_G-I is meant by the time interval from the summit (d_G) of the diastolic wave to the beginning of the tone segment of the first cardiac tone. d_G-Y is meant by the time interval from the summit of the diastolic wave to the valley (Y) of the diastolic collapse. 1. At first, the venous pulse waves in auricular fibrillation or flutter were analyzed and the correlation between ATZ ("Austreibungszeit") of the systole in question and d_G-I of the preceding systole was investigated. Taking the preceding d_ Q-I to the absissa and ATZ to the ordinate, curves bearing a close resemblance to Starling's are obtained; this fact has been already elucidated by our collaborators Kinoshita, Tachibana (1957) with respect to the left cardiac chambers. d_G-I exerts a certain influence upon ATZ of the following systole, i. e., its stroke volume. This relationship can be recognized in any type of Weber's classification observed in the cases with auricular fibrillation or flutter. 2. So far as d_G-Y, i. e. so-called rapid filling time is concerned, such a relationship as observed regarding d_G-1 can not be seen. That is to say, ATZ of the followingsystole or stroke volume and d_G-Y do not show such a curvi-linear correlation as recognized respecting d_G-I; however, the preceding d_G-Y appears to have a tendency to be confined to a certain limitation at any length of ATZ, in spite of the considerable exception. In order to draw the difinite conclusion about the latter item., further research may be necessary. 3. Weber's classification of venous pulse waves observed in absolute arrhythmia was investigated in detail and the frequency of the occurrence of his five types was examined in those cases above mentioned. The existence of the type which may with greater properiety be termed as "intermediary type" and of the type suitable for the denotation as "mixed type" were demonstrated. Furthermore between these patterns and cardio-vascular dynamics, a thorough examination was madeJor the presence of the relationship.
- 千葉大学の論文
- 1958-09-28