右心力学的数値の吟味
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概要
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Although recently the knowledge upon the hemodynamics of the right heart in man has been highly advanced, the exact time-relationship of the right cardiac action still remains unknown. In this paper, an attempt was made in order to reveal the time-relationship during the systolic phases in the right heart which was estimated at several time-points on the pulmonary arterial (PA) pressure curves obtained by the right heart catheterization. For a more complete interpretation of the results, the hemodynamics of both pulmonary and systemic circulations were literally at the same time determined. The minute volume was measured by Fick-Cournand's principle. The pulmonry volme elasticity coefficient (E'p) was calculated by R. Knebel's method already investigated in our laboratory. The left cardiac dynamics was analyzed by Blumberger-Holldack's method, while the systemic vascular dynamics by Wezler's method. Among the recordings of 28 patients with various circulatory disorders and the other 12 with normal circulation, only 19 cases were available for the exact determination of the time-relationship of the systolic phases. 1. Analyzing pressure curves thus precisely selected, it was found proper that the systole of the right heart was also subdivided into four phases, i. e. transformation period [Umformungszeit, UFZ'; (') is meant by the right ventricular dynamical value], pressure elevation period (Druckanstiegszeit, DAZ'), UFZ' + DAZX', i. e. tension period (Anspannungszeit, ASZ') and ejection period (Austreibungszeit, ATZ') on the analogy of the left cardiac dynamical values. Therefore, it may be safe to say that O. Bayer's assumption and proposal about these dynamical values obtained from the PA pressure curve secure both reality and clinical utility. 2. Methodically the determination of these dynamical values was confirmed to be available for the analysis of the right cardiac dynamics just the same as Blumberger-Holldack's method for the left cardiac dynamics. 3. Some technical difficulties in obtaining a satisfctory recording without any artefacts of the pressure curve, not rarely reduce the utility of this method in practice. Thus, the analysis described in this paper could be achieved only in 40% of the whole trials. 4. Such a reaction of pressure work (Druckreaktion) or volume work (Volumereaktion) as observed in the left cardiac dynamics could be also recognized in the right cardiac dynamics under certain limited circumstances. 5. According to whether the pathological condition affects the hemodynamics of either side of the heart more predominantly, the discrepancies between both sided cardiac dynamics may or not appear. Moreover such occurrence often depends upon the stage of the disease. 6. The time-relationship of the right cardiac dynamics to the ejection gets looser after the successful digitalization, when the pulmonary congestion is removed and the PA pressure is lowered; whereas the left cardiac dynamics indicates more closely the time-relationship to the ejection. 7. However the mode of the changes in the right cardiac dynamics seems to approximate that in the left cardiac dynamics, when the PA pressure is elevated and the overfilling of the right heart occurrs.
- 千葉大学の論文
- 1963-03-28