肺循環系におけるPeaking現象,とくに,肺循環力学的因子を中心にして

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The amplitude of arterial pressure wave i. e. the arterial pulse pressure increases progressively, as the wave passes away from heart. This is so-called peaking of arterial pulse which is a well-known fact in the research field of biophysics since Hiirthle and O. Frank. As the knowledge upon the. peaking of arterial pulse is very necessary in order to study the significance of standing or stationary wave, several engraved works upon this problem are still from time to time published, especially by Hamilton and Dow (1939), Wetterer (1954). However there exists only a few clinical observation about the peaking-phnomenon, especially with reference to the lesser circulation. The study upon the peaking phenomenon in pulmonary circuit is also of decided importance attempting the circulatory dynamical analysis of lesser circulation, so that the following observation has been made in our laboratory since these four years. Method : The pressure waves at the pulmonary arterial stem, its main branching and its periphery close to the position for so-called wedging were respectively registered by means of straingage-transducer. On the other hand Fick-Cournand's and Wezler's methods were simultaneously performed, thus there were measured cardiac output, total pulmonary as well as pulmonary arteriolar resistance, besides pulmonary vascular volume elasticity module (E'p) by Knebel's precedure and right ventricular dynamical values by O. Bayer's. Then, the contours of pressure wave and the relationship between changes in pressure at three positions and cardiovascular dynamical values as mentioned above, were investigated under due consideration upon the findings obtained by the aortic catheterization which was iriade in normal health and arterial hypertension. The twenty examinations were made in seventeen subjects, i. e., six normal controls, five cases with pulmpnal precapillary disturbance, four with mitral stenosis (m. s.), one with auricular fibrillation in addition to m. s. and one patient who was apparently free from any cardiovascular disorders but showed a transitory auricular fibrillation (a. f.) in the midst of the venous catheterization. Results : 1. Changes in the wave pressure at the withdrawal of catheter from aorta. As the wave passed away from the veering point between subclavian and brachial artery, the peaking became increasingly remarkable in normal health as well as in arterial hypertension, and in the latter there appeared the peaking more markedly than in the former. Furthermore the latter showed both, increase in E' or total peripheral resistance and decrease in damping factor. 2. Changes in the wave pressure in the pulmonary arterial system. a. As a rule, the peaking was seen in the main branching position of pulmonary arterial stem, but it was already missing at the periphery defined by us as mentioned above. In m. s. changes in wave pressure remained but little through stem, branching and periphery, especially in those patients who were complicated with pulmonary congestion, the wave pressure went down gradually without any peaking as the wave passed away to the periphery. b. While the peaking at branching position was not so remarkable in congestive heart failure with a.f., it was rather well recognized in one apparently normal subject who showed accidentally a transitory fibrillation in the midst of the observation. c. So far as this observation was concerned, there could scarcely be seen any distinct correlation between peaking phenomenon and- dynamical values of right ventricle as well as of pulmonary arterial system. 3. Changes in the conotours of pulmonary pressure wave depending upon the positions of registration. a. The pressure wave velocities differed from the registrating sites; the ascending rate of the front of wave increased and became steeper as wave passed away to periphery. b. In diastolic portion of stem-curve which was gained at the position close to the pulmonary valve, the incisura became shallow and the slight positive wave immediately after the incisura decreased gradually in its height as the pressure wave pessed away to the periphery. In periphery-curve a dip was gotten followed by second hump corresponding to dicrotic notch and dicrotic wave as often called respecting the arterial pressure wave of the great circulation. In turns as normal health, precapillary disturbance, and m. s., the incisura of stem-curve became relatively shallow and the dicrotic notch became relatively small. c. The contours of pressure waves registered at three respective positions were compared each other as follows : I. The pressure wave obtained at pulmonary stem and its main branching showed the contours similar to those at aorta, but the characteristics of pressure wave in distal portion of aorta could not be observed in peripheral portion of pulmonary artery. II The relatively large deflections of pulmonary pressure wave such as deflection just before the front of systolic wave and incisura were seen relatively, markedly even in the registration at the periphery, however their amplitudes became smaller and not rarely disappeared. III As the pressure wave passed away from pulmonary valve, both peaking and steeping phenomena could commonly be found at a certain point, especially at the main branching of pulmonary stem. IV In the periphery of pulmonary artery both peaking and steeping phenomena became so dim that they could often hardly be seen. V There existed some exception regarding the mode of change in the contours of pressure wave mentioned above ; for instance, in some subjects suffered from m. s. complicated with congestive heart failure, the descending portion of pressure wave tended to show a more or less monotonous declination without up- and downward deflection as the pressure wave passed away from pulmonary valve.
千葉大学の論文
1961-11-28

肺循環系におけるPeaking現象,とくに,肺循環力学的因子を中心にして

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