安静時,ならびに,運動時における心・脈管疾患の心拍量,とくに,Keys-Friedell法による研究
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Measurement of stroke volume was studied simultaneously by Keys-Friedell's and Wezler's methods as contrasted with Fick-Cournand's principle. In order to compare with Wezler's and Fick-Cournand's values, the x-ray kymograph was taken in supine posture. These three sorts of measurements were made before and after orthostatic and exercise tests according to Knipping-Bolt's principle. 1. In normal health, except for one case with lateral plateau, among twenty-eight, the volume difference during one cardiac cycle estimated by Keys-Friedell's method showed the linear relationship to the stroke volume surveyed by Wezler's method. KeysF-riedell's value of the case with lateral plateau was found smaller than Wezler's. By means of somewhat modified Keys-Friedell's method, the stroke volume in normal health was determined 71.5 cc on the average, and the cardiac. output 5.2 l., the cardiac index 3.19 l/min m^2. 2. Fifty cases with essential hypertension were divided into several groups according to age, Keith-Wagener's and Wezler-Boger's classifications. Except for patients with lateral plateau, in each itemized group the correlation between Keys-Friedell's and Wezler's values observed in normal health could be approximate found, almost apart from the existence of ventricular hypertrophic or strain curve in electrocardiogram, Keys-Friedell's value was smaller than Wezler's in the group with lateral plateau. 3. In the group with aortic regurgitation, either compensated or decompensated, Keys-Fiiedell's value was smaller than Wezler's without any similar correlation seen in normal health. Keys-Friedell's value of compensated aortic insufficiency was larger than that of normal health. 4. In the group with mitral insufficiency, either compensated or decompensated, Keys-Friedell's value was larger than Wezler's, without any similar correlation seen in normal health. 5. In mitral stenosis there could be observed the similar correlation between Keys-Friedell's and Wezler's values seen in normal health. 6. In pulmonary stenosis (1 case) and cor pulmonale (3 cases), Keys-Friedell's value was in proportion to Wezler's, whereas in ventricular septal defect (2 cases) this correlation could not be determined. 7. In the majority of cases suffered from angina pectoris which showed lateral plateau, Keys-Friedell's value was smaller than Wezler's, while in the minority without lateral plateau, there could be approximately found the relationship seen in normal health. 8. In hyperthyrosis (6 cases) there could be observed the similar correlation between Keys-Friedell's and Wezler's values seen in normal health almost independently from the height of the basal metabolism. 9. In anemia (5 cases) the similar tendency as in hyperthyrosis could be determined; Keys-Friedell's value showed the pattern of "overactive hart". 10. Except for the case with lateral plateau, in renal hypertension (8 cases) and miscellaneous diseases (11 cases) there could be approximately seen the relationship between two sorts of values observed in normal health. 11. In five cases with various kinds of circulatory disorders there were investigated Keys-Friedell's, Wezler's and Fick-Cournand's values simultaneously determined, and the sources of error were dwelt upon in each case; the difference of the sites of measurement would be assumed to the principal cause of the divergence. 12. By the application of these methods above mentioned, the circulatory dynamical analysis was performed before and after the standerd exercise test in normal health (2 cases), bronchial asthma (1 case) and various hart disorders (10 cases). The significance of the results was closely discussed by quotation of the studies made by author's collaborators especially as to normal health, mitral stenosis, hypertensive cardiac disease, and coronary insufficiency. 13. The orthostatic circulatory dynamics was investigated by means of the procedure above mentioned, and the significance of "centralisation" in Duesberg's sense was considered by citation of the results elucidated by author's collaborators, particularly as to the divergent opinions of Schellong and Wezler. In whole, even if Keys-Friedell's method has failed to achieve accurate estimation of stroke volume for many reason and already been destined to be substituted for electrokymographic procedure, yet this would hold still a significant step in cardio-vascular analysis since it would afford a simple and economical method for continuously and, repeatedly recording a function which appears intimately related to cardiac output without physical and mental stress of patients.
- 千葉大学の論文
- 1958-09-28