高送血量性負荷時の循環動態,とくに,貧血症,および,甲状腺機能亢進症について
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概要
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Cardiovascular dynamics were estimated by means of Blumberger-Holldack's and Wezler's methods in 62 cases with various sorts of anemia, in 35 with hyperthyroidism. Simultaneously circulating blood volume, circulation time, venous pressure, electrocardiogram, x-ray kymogram and blood gas were examined, and the existence of the correlation between these findings and cardiac output (Vm) was investigated. Anemia was classified into group A and B accordingly Schulten's scheme. The group A (37 cases) included chronic hemorrhagic anemia, iron deficient anemia and hemolytic anemia. The group B (25 cases) contained leucemia, Hodgikin's disease, hypoplastic anemia and Banti's symptom complex. The anemia subsequently due to cardiac disorders, hypertension, hepato-renal disease and cancer were excluded from this observation. Both Hb content and Vm were plotted in considerably wide limits, however there were roughly found such a tendency that the lesser Hb became, the more Vm increased. The clear correlation could not be observed between Vm and erythrocyte-number. In majority of cases..the arterial pressure tended to remain at the relatively lower level despite of within normal range. i Among the most of patients whose Hb (Sahli) showed 30 % and less, both high output and "Entspannungsregulation" in Duesberg's sense were observed. As the advanced reduction of Hb the cases with "Volumen-reaktion" in Blumberger's sense increased in number. But there could not be seen any clear-cut difference of the tendency above mentioned between A and B group. The relationship between basal metabolism and cardiac output found in the hyperthyroidic group had certain points of resemblance to that between Hb content and cardiac output observed in the anemic group. But the arterial pressure level of the hyperthyroidic group was used to somewhat be raised on the average. The cardio-vascular dynamics was observed in the anemic group A, B and the hyperthyroidic group. The peripheral flow resistance (W) was found more or less lower in all three groups, but in the hyperthyroidic group it occasionally remained within normal limits. Volume elasticity coefficient (E') decreased in inverse proportion to the increase in Vm, however to tell the detail, on the average E' of the group B was higher that of A and E' of the hyperthyroidic group exceeded that of the anemic. The similar tendency could also be found as to the pulse wave velocity. The cardiac work increased roughly in proportion to Vm among three groups. The mean increase of the hyperthyroidic group in the cardiac work was more marked than that of the anemic group. Cardiodynamically in the hyperthyroidic group the case with high output tended to display the volume reaction, whereas the case with low output to exhibit the pressure reaction. The venous pressure was not so much closely related to Vm, however the cases with venous pressure higher than 120 mmH_2O frequently showed the high output. In the anemic group the plasma volume generally increased inverse proportion to the decrease in the blood cell volume although there existed the reduction of the total blood volume in certain cases. Both blood cell volume and plasma volume of the hyperthyroidic group were, as a rule, augmented, yet there were found some exception that these two values ranged below the normal range notwithstanding the existence of the high output. In these three groups lobeline-, Evans blue- and N_2O time tended to be reduced, but there could be observed a pretty large number of the cases with moderately prolonged Decholin-, and ether time. So far as this observation was concerned, venous pressure, circulating blood volume and circulation time were not always in proportion to Vm. However total circulating blood volume × venous pressure ÷ circulation time (Evans blue method) was roughly in proportion to the cardiac index in the anemic group A and the hyperthyroidic, although this tendency could not be recognized in the anemic group B. In the anemic group the cases with reduced O_2 capacity tended to show the high output on the average. The arterial O_2 saturation of two patients with high output in the anemic group B was found less than 90%. The.anemicgroup A and B did not show the conspicuous change in AV O_2 difference despite of the increase in O_2 extraction coefficient. Except for three cases of the anemic group B, the arterial CO_2 content ranged almost within the normal limits. Electrocardiographically the left position of a slight extent could be often observed in three groups, and one case of the anemic group B showed the marked right axis deviation. P-dextrocardiale was not rarely found, especially in the hyperthyroidic group. QRS duration was prolonged in some cases of the anemic group B. The abnormal deviation of ST-T tended to be found in the cases with high output, especially in the anemic group B. The prolonged QT duration was found mostly in certain number of the anemic group B and the hyperthyroidic group. U wave could be frequently in all three groups. The cardiac surface determined by x-ray kymography had a tendency more or less to increase in proportion to the augmentation of Vm in all three groups, though this relationship in the hyperthyroidic group was only of slight extent. Longitudinal-, transversal diameter and breadth of heart tended to increase in proportion to the augmentation of Vm in the anemic group A and.the hyperthyroidic group, whereas in the anemic group B the increase of breadth was of slight extent in comparison with that of either longitudinal or transversal diameter. In addition, the appearance of plateau was often seen in the anemic group B. At one time of 90 examinations in the anemic group and 6 times of 66 examinations in the hyperthyroidic group there could be found Hegglin's synerome. In all these cases QT rate (Bazett) was prolonged, QTc-Q-IIc (Wuhrmann) was estimated above 0.05" except for the anemic case among them. Cardiodynamically 3 cases showed the normal reaction, 4 cases the volume reaction. High output was found in 3 cases; there was no case with low output among them. Venous pressure was less than 110mmH_2O. There could not be any significant relationship between the occurrence of this syndrome and Hb content or BMR. In all these cases either serum Na or K tended to decrease in amount, and dysproteinemia could be observed in five cases of them.
- 千葉大学の論文
- 1959-03-28