エレクトロキモグラフと物理的心・脈管力学的分析
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概要
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Instead of the direct connection to the recording system, the electrokymogram is first lead to the mingopraph (Elema & Co.), and then being ascertained the position of "Schlitz" as well as the condition of photography, electrokymogram is recorded on the oscillograph. If the phasic analysis needful enough for the clinical purpose is possible to be performed at certain time points of cardiovascular significance, the nuisance attached to the original method of Heckmann may not only simplified, but also the cardiac configuration may be more apprehensively obtained. Viewed in this light, the following observation has been made. As the standard time R of ecg is adopted with due regard to the time delay of electrokymography. In order to more or less quantitatively interpret the phasic analysis, the amplitudes of the x-ray kymogram almost simultaneously taken are measured (and corrected at the sites corresponding to those of electrokymogram, and then from the rates of x-ray kymographic to electrokymographic amplitudes, the presumable "actual" movements of cardiac margins at several cardio-dynamical time points are calculated. In addition, in order to be easy to understand, the figures are all drawn by five or ten times enlargement. Agreeing with the results of M. Suzuki, one of our collaborators, the time delay of electrokymography is likely to be beyond 10σ. This problem has been further studied as follows. The figures are drawn in three ways, that is, 1° when electrokymographic curve is assumed not to be delayed for ecg-curve (when the electrokymographic time point corresponding to the initiation of the ventricular activity is assumed to agree with the electrocardiographic Q), 2° when the time delay is assumed to be 30σ (when the electrokymographic time point is assumed to almost agree with electrocardiographic R), 3° when the time delay is assumed to be 50σ. Thus the most possible time delay has been investigated on the basis of the cardio-vascular dynamical values simultaneously obtained by the methods of Blumberger-Holldack and Wezler. The cardiac figure varies pretty markedly according to the assumption of the standard time. The cardiac figure obtained on the assumption that the initial point is R resembles more or less the configuration obtained on the assumption that the time delay is 50σ however the former figure differs considerably from the cardiac figure obtained on that the standard time is Q, therefore the most appropriate figure seems likely to be obtained granting that the time delay is from 30 up to 50σ. The following observations have been performed assuming that the time delay is 30 a and R of ecg is the initial time point of the mechanical activity of the heart. Not with mention, "Umformungszeit (UFZ)", "Druckanstiegszeit (DAZ)", "Anspannungszeit (ASZ)" and "Austreibungszeit (ATZ)" of left ventricle express the functional time duration of the cardiac activity, therefore the changes in the cardiac configuration characteristic to the respective time point may not always be expected to obtain. However Heckmann studied to gain the configuration during ASZ which has been called as "Latenzzeit" by him. The cardiac configuration at the end of ASZ was observed in twenty-four hypertensive patients with relatively long ASZ due to left ventricular pressure load, but without abnormal movement of cardiac margin due to valvular disturbance and so on. There was examined the relation between ASZ and the time-duration from the beginning of the cardiac contraction on electrokymographic curve at a, b, c & d up to the latent time, i. e. the transfere of the contraction into the rapid internal movement. Next there was examined the relation between ASZ and the isometric phase, i. e. the time duration from the beginning of the contraction on electrokymographic curve at f & g up to the transfere of the contraction into the distinct external movement. The latent time at a & c tends to be longer than ASZ, whereas the latent time at b & d occasionally to be approximate to ASZ. However about the direction of these changes, there exists hardly any definite correlation between the latent time at a, b, c & d and ASZ. The isometric phase at g bears more closely a resemble to ASZ than that at f, whereas the isometric phase at g & f is more correlative to ASZ than that at a, b, c, & d. Then the relationship between the isometric phase at f & g and the latent time at a, b, c, & d was examined. The fact that ASZ is, as a rule, longer than the latent time according to Heckmann presents the following three questions. 1. Whether R of ecg may reasonably be assumed as the time point of the beginning of ventricular contraction or not? 2. On this occasion whether the antero-posterior movement of heart also plays a part in or not? 3. Whether it may be theoretically significant to examine the electrokymographic curve at the end of ASZ or not? Therefore the latent time was measured at the site of the left ventricular margin which showed the most marked movement (c & d) and then this time duration was compared with ASZ. The movement of the electrokymographic curve until the time point at which the distinct initiation of the internal movements of c & d can be seen, does hot show any functional movement of cardiac margin.. So that the phasic analysis of electrokymographic curve at the end of ASZ is both functionally and morphologically significant. Furthermore in order to clarify the morphology during the rapid ejection, the phasic analysis was studied at another point, i.e. at the end of time duration from Q of ecg to the summit of carotid pulse wave (Q-Ct). The internal movement of electrokymographic curve at the end of Q-Ct & ASZ tends to increase in its magnitude as the preceding cardiac cycle length is prolonged. Next the relationship between cardiac dynamical time durations and the magnitude of electrokymographic movements at the endpoints of the respective time durations was studied. UFZ isindifferent from the preceding cardiac cycle length and remains almost constant, therefore the significant relationship can not be seen between the length of UFZ and the magnitude of the movement of cardiac .margin. The movement of electrokymographic curves at the end of Q-Ct & ATZ and QIE increased in their magnitude as the time durations were prolonged. Lastly both the ejection time at the aortic arc and the .circulatory dynamical values were observed and compared in arteriosclerotic patients for example of the subjects with large vascular volume elasticity coefficient E' and hyperthyrotic patients for the example of the subjects with high output.
- 千葉大学の論文
- 1962-11-28