心性呼吸困難の呼吸動態,および,循環動態について : 附:心冠カテーテル法による数種の心冠脈管拡張薬の臨床的評価

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38 cardiovascular patients were divided into two groups, i. e. the group A (19 cases) had no dyspnea, while in the group B, 10 cases were possible to take recumbent posture, 7 cases required to recline in easy chairs, and two remains were compelled to sit on bed with slouch, owing to dyspnea. Vital capacity (VC): predicted VC×100 was found larger in the group A than in the group B, and its increasing rate due to orthostatism was usually observed greater in the group B than in the group A. The similar tendency, although less marked, was seen in the group B with regard to maximal breathing capacity (MBC): predict. MBC×100 or breathing reserve (BR): MBC×100, residual volume (RV): total lung capacity (TLC)×100 and O_2 equivalence (O_2E) were found, as a rule, larger in the group B than in the group A, but the reverse relation was often seen with respect to arterial O_2 saturation (O_2 sat.). Arteriovenous O_2 difference (a-v. O_2 diff.) and O_2 Extraction Coefficient (O_2 Ex. Coeff.) were seen apparently greater in the group B than in the group A, however, arterial CO_2 content (art. CO_2) was estimated not rarely lower in the group B than in the group A. Venous pressure (VP) was measured higher in the group B than in the group A, and in the group B there was found the rough pararellism between VC: pred. VC×100 and height of VP. The similar tendency in the group B was also significantly seen as to MBC: pred. MBC×100, BR: MBC×100 and RV: TLC×100 and O_2E. There could not be observed any certain relationship between a-v. O_2 diff. or O_2 Ex. Coeff. and VP. In both groups, 5 cases were of low output, and two of high output. There could not be assured any integrated correlation between the amount of minute volume and the degree of respiratory disturbance. The decrease in VC: pred. VC×100 and the increase in circulating time tended to be more frequently observed in the group B than in the group A, and also the similar relation between circulating time and MBC: predt MBC×100, BR: MBC×100, RV: TLC×100, O_2E or art. O_2 sat. could be seen more or less markedly in the group B than in the group A. There existed no clear-cut interrelationship between circulating time and a-v. O_2 diff. or O_2 Ex. Coeff. among both groups. The diminution of breath-holding time ran roughly pararell with the raspiratory disturbances, i. e. those of VC: pred. VC×100, MBC: pred. MBC×100, BR: MBC×100, RV: TLC×100, O_2E or art. O_2 sat.; there existed the significant difference in the degree of this pararellism, above mentioned, between the group A and the group B. However there could not be found any integrated relationship between breath-holding time and a-v. O_2 diff. or O_2 Ex. Coeff. in both groups. Besides the examination of the respiratory function, cardiovascular dynamics was strict simultaneously studied in 35 among 38 cases by means of Wezler's and Blumberger-Holldack's methods. While among 19 cases of the group A the pressure relation (Blumberger) was seen in 9, the normal reaction in 6, and the volume reaction in 4 cases, among 16 cases of the group B the pressure reaction was found in 13, the normal reaction in 2 and the volume reaction in one case; whereas the vascular dynamical values in both groups changed disversely case by case. In the group A even those who showed the pressure reaction in the cardiodynamics, VC: pred. VC×100, MBC: pred. MBC×100, BR: MBC×100, RV: TLC×100, O_2E, or O_2 sat. existed usually within or in the vicinity of the normal range. In the group B those who had the pressure reaction mostly showed these respiratory data below the normal extent. The fluctuation of a-v. O_2,diff., or O_2 Ex. Coeff. showed no clear-cut tendency among the cases of both groups with "pressure" reaction. In the most part of patients among the group A who showed the normal or the volume reaction in the cardiodynamics, the values of the respiratory function existed within the normal range, whereas among the group B even those who had the "normal" or the "volume" reaction were more frequently complicated with the marked abnormal values with respect to the function test above mentioned. The changes upon the respiratory and eardiovascula dynamical values found in both groups before and after the treatment of the underlying diseases were explained in detail case by case. Appendix: Bing's coronary sinu.s catheterization, Wezler's and Blumberger-Holldack's cardiovascular dynamical analysis were simultaneously, in the strict sense, performed, in three cases with compensated arterial hypertension and two cases suffered from hypertensive cardiac disease complicated with anginal attacks, in order to clarify the clinical value of so-called coronary dilatators. The values of Bing's method estimated by us in normal health were as follows; respiratory quotient (RQ) 0.80, minute volume (Vm) 6.09 L/min., coronary blood flow (CBF). 61cc/100g/min., CBF: Vm 1.0%, myocardial O_2 cosumption (MOC) 5.99 cc/100 g/min., coronary venous mean pressure (CVMP) 4.9 mmHg, coronary vascular resistance (CVR) 1.3, left ventricular work (LVW) 6.62kg. m/min. In the compensated hypertension, RQ was estimated within the normal range, Vm Was meassured slightly decreased or in the normal upper limit, CBF was determined fairly increased or in the normal lower limit, CBF: Vm was counted considerably increased or within the normal extent, MOC was calculated fairly increased or within the normal range, CVMP was found normal or slightly increased, CVR was reckoned almost within the normal or slightly increased, CVR was reckoned almost within the normal limit, LVW was computed within the normal extent or decreased. In the hypertensive cardiac disease complicated with anginal attack the following results were obtained. RQ was estimated within the normal range. Vm was meassured fairly or slightly increased. CBF was determined within the normal extent or increased. CBF: VM was counted in the normal lower limit on the one hand, increased on the other, MOC was found decreased. Brachial arterial mean pressure (BAMP) was meassured moderately increased. CVMP was estimated within the normal range. CVR was calculated slightly increased on the one side, in the lower normal limit in the other. LVW was reckoned within the normal range. According to Wezler's analysis, one case was found of M type, the other of M+W+E'. Both cases showed "pressure" reaction in the sense of Blumberger. The results gained 30〜40' after the intravenous injection of 10 cc of Lacarnol "forte" or 200 mg of Theophylline cholinate in the compensated hypertension were as follows: RQ decreased in three cases to the normal range. Vm increased in two cases and decreased in the other to the normal extent. CBF decreased to the normal range in two cases and increased to the normal limit in the other. CBF: Vm decreased to the normal range in two cases and increased to the normal limit in the other. MOC decreased to the normal range in two cases and increased to the normal extent in the other. BAMP tended to be normalized. CVMP remained unchanged in the first case or decreased in the second, but in the third showed the slight augmentation. CVR increased in two cases to the normal limit and decreased in the other to be normalized. LVW increased in one case, and decreased in the other two. BAMP remained unchanged or slightly decreased. According to Wezler's analysis, W remained unchanged or slightly decreased. E' also remained unchanged in the first case and increased a little in the second, whereas slightly decreased in the third. ASZ and ATZ were all affected to be normalized. In the group with hypertensive cardiac disease, case 5 was injected with 10 cc of Lacarnol "forte" and case 6 with 5 cc of Lacarnol in addition to 0.125 mg of k-Strophantin (Strophosid "Sandoz"). The results gained 30〜40' after the injection, were as follows: RQ was normalized in both cases. Vm remained unchanged in case 5, and slightly decreased to the normal extent in case 6. CBF increased to be normalized in case 5, and slightly decreased but still remained beyond the normal range. CBF: Vm increased to the lower normal limit in case 5, and decreased to its upper limit in case 6, MOC increased Slightly in case 5. BMAP did not show the essential change in case 5, but was slightly elevated in case 6. CVMP decreased even below the normal range in case 5, but increased a little beyond the normal limit in case 6. LVW remained unchanged. According to Wezler's analysis. W and E' increased slightly despite of the changes within the normal range in case 5, but decreased moderately to be normalized in case 6. The "pressure" reaction in the sense of Blumberger were seen to be normalized in both cases.

心性呼吸困難の呼吸動態,および,循環動態について : 附:心冠カテーテル法による数種の心冠脈管拡張薬の臨床的評価

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