エレクトロカイモグラフィーと心・脈管力学的分析法について,とくに,大動脈硬化症の診断を中心に
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Respecting the aortic sclerosis, the pulsation curve of the aortic wall is investigated by means of Eky in this paper. The pulsation of the aortic arc was registered in the dorsoventral direction in recumbency and standing (at the point G according to Heckmann), and that of the anterior wall of ascending aorta in the first oblique position (at the point A named by us). The Eky and the cardio-vascular dynamical values were simultaneously studied. In normal health, "Rasche und reduzierte Austreibung" could be distinctly identified at the point A, but the incisura followed to the 2nd cardiac tone was vague. The cardio-vascular dynamical values in standing as compared with those at lying showed the reduced Vs, Vm, the augmented W, E', that is, vasculo-dynamically the "Anspannungstyp" in the sense of Duesberg-Schroeder, whereas cardiodynamically the increased DAZ, ASZ, the decreased ATZ, that is the "Druckreaktion" in the sense of Blumberger. Heckmann demonstrated the characteristic pattern of Eky at the point G in aortic sclerosis (Fig. 3). About 14 subjects of essential hypertension with or without aortic sclerosis, the point G in lying, the point A and G in standing were observed in order to study whether the characteristic pattern emphasized by Heckmann has any close relationship to the circulatory dynamics or not. When Eky was registered at the point G in lying, the amplitude was small and its summit was sharp, in additon, no small wave existed on the descending limb, that is, in these cases the characteristics according to Heckmann was evident. By the way, C, E' and Vz were estimated beyond the normal limits. However even when Heckmann's characteristics was evident in the curve registered at the point A, there existed a certain number of subjects who showed the circulatory dynamics in the normal range (Fig. 5). Tbl. 4 shows the electrokymographic findings of 14 hypertensive patients registered at the point A in standing, the cardio-vascular dynamical values in lying and the orthostatic adjustment of circulatory dynamics. Tbl. 5 shows the electrokymograhic findings of four subjects registered at the point G and A in standing and the circulatory dynamics in lying. There could not be seen any distinct relationship between the circulatory dynamics and such patterns as Heckmann pointed out. Moreover there was scarcely found the difference between the pattern registered at the point A and that at G. This difference depends upon that E', C and Vz represent the whole state of aortic "Windkessel", whereas the electrokymographic pattern the local rigidity of it. In order more briefly to elucidate the relationship between circulatory dynamics and electrokymographic patterns, the patient suffered from auricular fibrillation was observed. By means of the statistical treatment of the data, thers was assumed the existence of the relationship presented by Y = a+bx, where a, b and the correlation index r were calculated. a) The relation between blood pressure level and amplitude of electrokymographic curve. The amplitude is conceivable to depend upon the pulsating change in the intra-aortic pressure, so that, upon the change in pulse pressure. In one victim of hypertensive cardiac disease complicated with auricular fibrillation without any valvular disorder, as being in Fig. 16, the amplitude could be correlated to systolic pressure, but could hardly be to diastolic. The amplitude does not decidedly correlate with systolic or diastolic pressure, but only roughly with pulse pressure to a certain extent. Therefore the amplitude seems to depend upon some sorts of factors other than pressure level, for example, upon the anatomical position of aorta, the pulsating change in its position and the tension of aortic wall which may largely be prescribed by the mean area of internal crosssection and the amount of the distensibility due to systolic pressure rise. b) Vascular dynamical values and electrokymographic amplitude. The amplitude correlates with the peripheral streaming resistance as well as the vascular volume elasticity almost to the same extent (Fig. 17). But there exists no direct relationship between amblitudes and pulse wave velocities (Fig. 18). The correlation index found between amplitudes and stroke volumes was 0.90 at the point A and 0.78 at G respectively, thet is, considerably significant. This seems to be due to not only the lateral transposition of ascending aorta accompanied with the displacement of left ventricle, but also the lateralwards component of the impact of stroked blood against the wall of ascending aorta and furthermore the displacement of aortic arc which decreases in its convexity at every systolic stroke. c) Cardio-dynamical values and electrokymographic amplitudes. Among the cardio-dynamical values, ATZ correlates most intimately to the amplitudes registered at the point A and G. In addition, there can also be a considerable significant correlation between amplitude and Vs : ATZ or amplitude and cardiac work (Fig. 19). d) Appendix Between the rate of the dynamical mean amplitude to the maximal amplitude and E' : W i. e. the vascular damping factor, there exists the reversal correlation, and its correlation index is larger than that found between amplitude and either W or E' (Fig. 12). Tbl. 3 summarizes the results mentioned above; utilizing the circulatory properties of auricular fibrillation, there can be elucidated the existence of the good correlation between electrokymographic amplitude and cardiovascular dynamical values i.e. stroke volume, ATZ, pulse pressure, systolic pressure & vascular damping factor.
- 千葉大学の論文
- 1962-07-28
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関連論文
- 15.大動脈硬化のE. Ky的診断にかんする,2,3の問題について(第38回千葉医学会総会,第7回千葉県医師会学術大会連合大会演説要旨)
- エレクトロカイモグラフィーと心・脈管力学的分析法について,とくに,大動脈硬化症の診断を中心に