肺動脈容積弾性率,および,その臨床的意義について

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In 1952, Deuchar and Knebel, in 1956, Lasser and Amram applied Broemser-Ranke's "Windkessel" theory to the pulmonary circuit in order to determine the pulmonary volume elasticity coefficient (E'p). Deuchar and Knebel proposed to assume PV=0, whereas Lasser and Amram PV=5. In this report E'p was calculated in assumption of PV=Q or PV=5 as well as PV=PC where PC was estimated as the pulmonary wedge pressure obtained by the venous catheterization. Simultaneously as to the great circulation, Wezler's and Blumberger-Holldack's methods, as to the lesser circulation, O. Bayer's method were adopted in order to estimate the dynamical values. 1. In 8 healthy cases, the average of PA was 22.4/11.1 mmHg, PC SmmHg, Vm 5.751/min, and Wp (pulmonary peripheral resistance) 243.5 dyne sec cm^<-5>. E'p in normal health calculated as either PV=0 or PV=5 was used to be found approximately same. 2. In 11 essential hypertensive patients (Keith-Wagener II) the average of E'p (PV=PC) was 186.0 dyne cm^<-5>, so that there existed no marked difference as compared with that of normal health. 3. In bronchial asthma not complicated with pulmonary emphysema, the average of E'p (PV=PC) was 285.0 dyne cm^<-5>, whereas in bronchial asthma suffered from this complication it was 454.4 dyne cm^<-5>. 4. In 4 of 5 cases with mitral stenosis, both PA and E'p (PV=PC) were found larger than those in normal health in an average; the wedge pressure of all cases was elevated. In 1 of 3 cases with mitral stenoinsufficiency, E'p (PV=PC) was estimated larger than that in normal health. In mitral stenosis, E'p determined in assumption of PV=0 or PV=5 showed not seldom the marked deviation from that in assumption of PV=PC. 5. In 2 of 4 cases with aortic regurgitation, E'p (PV=PC) was found within the normal range, whereas in other two it was estimated beyond the normal. Among 3 patients suffered from aortic stenoinsufficiency complicated cardiac asthma, E'p was observed normal in 1 case, and larger than the normal range in 2 cases. 6. In one case with Ayerza's disease, E'p (PV=PC) was 4084 dyne cm^<-5>, that is, the largest value among this observation. 7. E'p tended to increase in its amount pararell with the elevation of systolic PA, mean PA, and pulmonary pulse pressure. However there could not be seen so closed relationship between E'p and pulmonary diastolic pressure in the lesser circulation as that between E' and arterial diastolic in the greater circulation. The reverse correlation existed roughly between the fluctuation of E'p and that of Vs in the same individual. 8. There was calculated the ratio of E'p to E' in the patients in whom Vm determined by Fick-Cournand's method was closely approximate to that by Wezler's simultaneously performed. Regarding E'p/E', mitral stenosis or stenoinsufficiency, bronchial asthma with or without pulmonary emphysema, essential hypertension of KW II, and normal health could be arranged in the order of the magnitude. In the same individual, the, damping factor in the lesser circulation tended to be observed larger than that in the greater circulation. 9. The intravenous injection of morphine (0.1 mg per kilo) augmented the E'p of mitral stenosis; thus resulted pulmonary hypertension, though transitory and slight, showed the type of W+E' (Wezler-Boger), whereas in the greater circulation there appeared the tendency of "Anspannungshypotension" (Duesberg-Schroeder). While the right ventricular dynamical values showed "Volumenreaktion" (Blumberger), the left ventricular changed from "Volumenreaktion" to "Normals Reaktion". 10. The intravenous injection of β-oxypropyltheophylline (ca. 2 mg per kilo) showed the tendency of "Anspannungshypotension" both in lesser and greater circulation of the patients suffered from bronchial asthma, however the tendency seen in the greater circulation was usually somewhat more marked than that in the lesser circulation. At this moment, bothsided ventricular dynamical values enhanced commonly the tendency of "Druckreaktion" previously existed more or less. In the essential hypertension of KW II, Vm previously augmented was not seldom rather reduced to some extent. There occurred no significant change upon PA. The intravenous injection of oxytheophylline reduced E'p calculated in assumption of PV=0 or PV=5, whereas it augmented E'p determined in assumption of PV=PC. However, in the systemic circulation, E' as well as W tended to become smaller by the injection. As to bothsided ventricular dynamical values, in the cases with marked "Druckreaktion" there could be seen the tendency of the decrease in its degree. 11. The intravenous injection of 0.25 mg of K-Strophanthin (Sandoz) augmented the Vm except for aortic regurgitation. The fluctuation of E'p remained within normal range. After the recompensation by Strophanthin therapy, the systemic circulation showed the tendency of the normotensive "Entspannungsregulation" (Duesberg and Schroeder) regarding peripheral dynamics as well as that of "Volumenreaktion" (Blumberger) respecting bothsided cardiodynamics. The injection of Strophanthin normalized the pulmonary "Anspannungshypertension" observed in some cases, whereas at this moment W and E' in systemic circulation increased slightly in their amount. In the patients with mitral stenosis or ravious kinds of valvular diseases complicated with pulmonary hypertension, the injection of Strophanthin lowered PA previously elevated, and reduced .Vm, although of slight extent. E'p and Wp formerly augmented were also diminished a little by the injection. ASZ' (right ventricular "Anspannungszeit") once prolonged tended to decrease in its degree. In the systemic circulation the high output showed the tendency to be reduced, W or E' rather somewhat enlarged. 12. The intravenous injection of 1.0 mg of Camphidonium salt (Ingelheim) lowered the systolic PA of mitral stenosis previously elevated, at this moment the diastolic PA remained unchanged or was rather raised although of slight extent, and Vm formerly diminished was augmented. E'p in assumption of PV=0 became smaller, whereas E'p in assumption of PV=PC larger. While the total pulmonary resistance decreased, the pulmonary arteriolar resistance increased in their amount. In the systemic circulation, W and E' were reduced, Vm remained unchanged or slightly increased in their amount. The left ventricular dynamical values showed the decrease in the extent of "Druckreaktion", whereas those of right ventricle rather the increase although of slight extent.
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肺動脈容積弾性率,および,その臨床的意義について

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