静脈々波を含むポリグラフによる右心系の新しい循環力学的分析
スポンサーリンク
概要
- 論文の詳細を見る
1. In 24 subjects in normal health, female and male, from 16 to 63 years of age the venous pulse wave were both photoelectrically and electromechanically registered, then the time-delay, the amplitude as well as the width of each protuberance and subsidence of the wave were measured. P-Cf and II-X photoelectrically registered were found longer than those of electromechanical records, I-Cf registered by the former was almost the same that by the latter. II-Dg and II-Y registered by the former were found shorter than those by the latter. Therefore electromechanically the width of the presystolic and the diastolic wave was recorded shorter and the width of the systolic wave wider than photoelectrically. The amplitude width varies to some extent, but there seems hardly to exist the difference of the width between two registrations. 2. In 21 subjects in normal health, female and male, from 15 to 63 yearsof age and in 13 patients with bronchial asthma, pulmonary emphysema and the other sorts of the pulmonary disease from 14 to 68 years of age, the influence of the respiration upon the venous pulse wave was studied. In the normal subjects the diastolic wave increases in its width, Dg-Y and Y-I are shortened in the insprium, thus Dg-Y/diastole increases and Y-I/ diastole decreases in its magnitude. However generally the tendency to these changes in the pulmonary disease is not so marked. The other sorts of the timerelation of the venous pulse wave show also hardly any change both in normal health and the diseased group. 3. In 2 normal subjects, each 2 cases of emphysema and bronchial asthma, each 1 case of mitral stenosis and aortic insufficiency, the intraesophageal pressure which is considered to be parallel to the intrathoracal pressure, the venous pulse wave, the carotid pulse wave, the phonocardiogram and the electrocardiogram were simultaneously registered 10 times and about 5 non-controversial of 10 registrations only the time-relation of the venous pulse wave was analysed. QII and QX were found indifferent from the height of the intraesophageal pressure. The range of the variation of II-Dg ane Dg-I was wider under the negative than the positive intraesophageal pressure, and this tendency was more remarkable in normal health than the diseased group. Dg-Y was prolonged and Y-I tended to be shortened as the intraesophageal pressure was raised; this phenomenon could be found especially striking in the mitral stenosis. 4. In 13 patients with emphysema, 25 cases of bronchial asthma without emphysema, 2 patients with kyphoscoliosis, each 1 case of pneumoconiosis, pulmonary fibrosis, postoperative state of the pulmonary lobectomy, senile lung and funnel chest respectively, the venous pulse waves were registered 66 times and 44 non-controversial of the registrations were analyzed. In the cases of emphysema the changes in the diastolic wave and the diastolic collapse were frequently observed and the premature appearance of the systolic collapse were often seen in the bronchial asthma without emphysema. Besides, the normal pattern of the venous pulse wave was more frequently observed in the bronchial asthma without emphysema than in the pulmonary emphysema. The abnormal presystolic wave and the knob-formation of the systolic collapse were more often seen in the bronchial asthma without emphysema. P-af. P-ag and II-Dg were prolonged, whereas Dg-I and Y-I were shortened in the order of normal health, bronchial asthma and pulmonary emphysema. The tendencies observed respecting II-Dg, Dg-I and Y-I were also seen regarding II-Dg/diastole, Dg-I/diastole and Y-1/diastole. 5. QX, and ASZ' (tension time of right ventricle) ATZ' (ejection time of right ventricle) were compared in the group with (1 case of mitral stenosis complicated with auricular fibrillation) or without arrhythmia (each 6 cases of the bronchial asthma and the mitral stenosis). In the group free from arrhythmia the lineal relation, i.e., the positive significance was observed between QII QX, except for the occurrence of the premature appearance of the systolic collapse. However such a lineal relation between ASZ' ATZ' and QX could not be found. In the group with arrhythmia, the relationship between QX and ASZ' ATZ' were also lineal, but of the reversal significance. In addition, a certain lineality, although it was not so striking, existed between QX and QII. In other words, it is suggested that QX of the venous pulse wave is more influenced from the systole of the left than the right ventricle. 6. In each 7 cases of the bronchial asthma and the mitral stenosis, both the patterns of the venous pules wave and the mean pressure of the pulmonary artery were compared. There existed no patient with the normal pattern of the venous wave pulse whose mean pressure of the pulmonary artery was raised beyond the normal range, but the abnormal pattern could not always be seen in the pulmonary hypertension due to bronchial asthma or mitral stenosis, that is, it may be safe to say that there exists no pathognomonic pattern of the venous pulse wave which enables to presume the height of the pulmonary arterial pressure. 7. In each 7 cases of the bronchial asthma with emphysema and the mitral stenosis, both the findings of the venous pulse wave and the dynamical values of the right ventricle were compared, and discussed under every item of the latter. 8. In 13 cases of emphysema, 25 cases of bronchial asthma without emphysema, 2 cases of kyphoscoliosis, each 1 case of the pneumoconiosis, the pulmonary fibrosis, the postoperative conditions of pulmonary lobectomy, the senile emphysema and the funnel chest respectively, the venous pulse waves were registered 66 times and 41 of all the registrations were studied with reference to both the results of the pulmonary function tests and the cardio-vascular dynamical values simultaneously recorded. 9. In 43 cases of arterial hypertension, 20 cases of bronchial asthma and emphysema, 15 cases of mitral stenosis, both the pattern of venous pules waves and the height of peripheral venous pressure were compared. The normal pattern of venous pulse wave could seldom be observed in the peripheral venous hypertension, but the abnormal protuberances and subsidences in the venous pulse wave appeared almost indifferently from the height of the peripheral venous pressure. 10. In 37 cases of auricular fibrillation the venous pulse wave were registered 75 times and 45 non-controversial of all the registration were analyzed. Plotting the length of the cardiac period on the axis of abscissa (x^^-) and the time-duration of the diastole or II-Dg, Dg-I, Dg-Y, Y-I , i. e. reflecting the "Entspannungszeit", "diastolische Fullung", "schnelle Fullung", "langsame Fullung" respectively on the axis of ordinante (y), than y =ax^^- +b comes into existence. It was calculated regarding the time-duration of diastole. Dg-I and Y-I that "a" was approximate to 1 and "b" became large as the heart rate was increased. Respecting II-Dg and Dg-Y, "a." was almost equal to 0 and "b" became small according to the increase in heart rate. About II-Dg there could not be found any definite tendency of the change in "b". When the preceding cardiac circle length is prolonged, II-Dg becomes small curving upwards concavely, but there exists any definite tendency of the changs in Dg-Y. Abbreviation I : the first cardiac sound II : the secondcardiacsound P : Pinecg. Q : Qinecg. af : foot-point of presystolic wave s. elevation ag : top of presystolic wave Cf : foot-point of systolic wave s. elevation Dg: diastolic wave s. elevation X : systolic collapse Y : diastolic collapse
- 千葉大学の論文
- 1963-07-28