左室不全の容積静脈々波の研究 : とくに,同時測定の血脈管力学的数値を顧慮して
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The venous volume pulse waves were electrophotographically registered on the rightsided jugular bulb and at the same time the cardio-vascular dynamics was analysed by means of both the Blumberger-Holldack's and our modification of the Wezler's method among 30 normal subjects (30 times' observations), 50 patients with arterial hypertension (59×), 24 cases of valvular disease (53×) and 15 patients with high output failure (18×), that is, 119 cases (160×) in a total. 1. On the basis of the data gained by the qantitative study upon the fluctuation of the venous volume pulse waves in the normal subjects, the criteria for the various pathologic patterns were presented (cf. Tb1. 2). According to these criteria there can be found no practical difficulties in distinguishing the spontaneous fluctuations of the venous volume pulse waves from their pathologic patterns. 2. Arterial Hypertension. 68% of the patients with arterial hypertension (69% of the observations in this group) showed some pathologic patterns in the systolic collapse which were closely related to the change in the cardiovascular dynamical values characteristic of arterial hypertension, therefore the pathologic patterns in the systolic collapse can be regarded as the major pattern of the venous volume pulse wave in arterial hypertension. The patients with early appearance of X (X: Terminus of Systolic Collapse) or the decrease in the depth showed smaller S.I. (S.I.: Stroke Index) and S.I./ATZ (ATZ: Ejection Time) as well as larger Pm/Vs (Pm : Mean Arterial Pressure, Vs : Stroke Volume) than those who were free from these findings of X. The wave-formed knob or the double knob implies almost the same diagnostic meaning as the early appearance of X or the decrease in the depth. Most of the patients only with the non-waved knob or without any pathologic pattern showed relatively large S.I. and S.I./ATZ as well as relatively small Pm/Vs.The patients with the early appearance of X, the decrease in the depth, the wave-formed knob or with the double knob were usually of the resistance plus elasticity (W+E') type, occasionally W or E' type according to the Wezler-Boger's classification of arterial hypertension. The patients only with the non-waved knob or without any pathologic pattern in the systolic collapse were mostly of the minute volume (M) type or the ill-defined type. 3. Valvular Disease Those who showed some pathologic patterns in the venous volume pulse wave were found 86% among patients suffured from congestive heart failure of various grades due to valvular disease (92% of the total observations in this group). However so far as this study is concerned, there can be found neither any definite pathognomonic pattern in valvular disease, nor such a characteristic pattern as detecting the advance of congestive heart failure. During the treatment of 15 patients of this group, the modes of the changes in Q-X_r, α_g-X_r, d_s-Y_r and d_g-I_r were observed. The modes of the changes in Q-X_r and α_g-X_r varied to every case or to every subgroup. And d_g-Y_r was increased in its magnitude by the treatment among four patients with mitral stenosis; besides three of them showed the significant augmentation of stroke volume. As a rule, there was found also the increase in ATZ/ASZ (ASZ: Tension Time). In the valvular disease other than mitral stenosis, d_g-Y_r is reduced or augmented as the case may be. In addition, the change in d_g-Yr does not correspond to that in cardiovascular dynamical values. When d_g-I_r increased in its magnitude by the treatment, stroke volume is usually at the same time augmented in most of the patients (8 of 10 patients with the increased d_g-I_r). However, converses are not always true. Although stroke volume is increased in its amount, d_g-I_r is not necessarily augmented, but occasionally decreased (3 of 11 patients with the increase in stroke volume).When venous volume pulse waves as well as general clinical findings are cautiously examined, some useful pieces of the information as to cardio-vascular states can be obtained. 4. High Output Failure (15 patients, 18 times' observations) Nine patients with hyperthyrosis (10×) and six cases of anemia (8×) were studied. It may be emphasized especially in hyperthyrosis that according to the augmentation of cardiac index, the patients with such high systolic waves as exceeding the normal range increase in their number. Both the hyperthyrotic and the anemic group showed various kinds of the pathologic patterns, above all, in systolic collapse (6 patients with hyperthyrosis and 4 patients with anemia). Such hyperthyrotic patients as denoting marked Hegglin-syndrome (QII-QT larger than 40σ) showed also the pathologic patterns in the systolic collapse (the early appearance of X in two cases, and the decrease in the depth of X in the other one case).
- 千葉大学の論文
- 1963-07-28