起立性低血圧症の心・脈管力学的分析,および,その自律神経緊張状態について
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The cardio-vascular dynamical analysis of Schellong's first and second test was performed by Blumberger-Holldack's and Wezler's method. The mode of changes in the cardiodynamics was divided into three types, that is, the pressure-("Druckreakreaktion", D.), the volume-("Volumenreaktion", V.), and normal reaction (N.) accrding to Blumberger. The mode of changes in the vasculodynamics was also classified into three types, i.e., the tension-("Anspannungsregulation", Ans.), the relaxation-("Entapannungsregulation", Ents.) and the normal regulation according to Duesberg-Sehroeder. 1. The abnormal fluctuation of the cardio-vascular dynamics in the recumbent state appears more frequently in the arterial hypertension than in the arterial hypotension. However, among the hypotensives whose subjective disturbances of orthostatism are severe, there occurs not seldom the cardio-vascular dynamics beyond the normal range. The difference between the cardio-vascular dynamical values at 5' and those at 15' after standing is not so remarkably found; generally speaking the values at these two time-points show very similar mode of reaction, therefore it may be safe to say that only the values at 5' after standing is sufficient for the practical study on the type of the orthostatic reaction. 2. The hypotonic ("hypotone") form of postural hypotension according to Schellong is usually attended with D.-reaction cardiodynamically and with Ans.-regulation vasculodynamically, whereas the hypodynamic ("hypodyname") form is often attended with V.reaction cardio-dynamically and with Ents.-regulation vasculodynamically. However there exists not rarely the exception to the tendency above mentioned and concerning this source the standard deviation, the spontaneous fluctuation of these cardio-vascular dynamical values as the reproducibility of Schellong's 1st and 2nd test were fully discussed. 3. Dern's analysis was made in arterial hypertension regarding the dynamical optimal state of blood pressure which were gained by the administration of the various sorte of the hypotensive drugs presented after Kikawada's observation in our clinic, i. e. guanethidine, chlorthalidone, cyclopenthiazide, chlorbenzene-2, 4-disulfonamide, 1-α-methyldopa, and some kinds of monoamine oxidase inhibitors. By the singular use of the latter it is difficult to obtain a stable optimal or floor state of blood pressure. Dern's analysis elucidates the autonomic nervous tonicity after the antihypensive treatment as our collaborators have emphasized. 4. The criterion for the judgement of the severity of the orthostatic dysfunction was made of the constituent factors of blood pressure range which were easily obtainable in the clinical praxis and then according to this criterion three subgroups, i.e. (-), (+) and (〓) were difined (Tb1. 6-7). 5. When the cardio-vascular dynamical values gained in the hyper-and hypotensives are investigated in the light of W. R. Hess' classification of the autonomic nervous tonus, there can be seen the tendency that the ergotropic pattern is more frequently found in the juvenile hypetension whereas the histiotropic is more often observed in the middle-aged. In the arterial hypotension and autonomic dystonia, generally speaking the ergotropic pattern is rarely found and the histiotropic pattern complicated with Ans.-regulation is frequently observed. 6. The mecholyl test according to the original principle of Funkenstein, Greenblatt and Solomon. The II' type was distinguished from Gellhorn's IE type owing to the marked fluctuation of both positive and negative direction far beyond the normal range, while the IE type of Gellhorn's classification were found 82% of normal health, 47% of autonomic dystonia, taking II' type into the consideration in normal health H type was seen 82% and the II' type 0%, whereas in autonomic dystonia the II type was recognized only 5% and the II' type 42%, therefore it appears to be clinically significant to separate the II' type from the II type of Gellhorn. 7. Adenosin-Suprifen-Mixture (Carnigen "Hoechst") 1-(3-Hydroxyphenyl)-1-hydroxy2-ethylaminoethane-chloride (Effortil "Boehringer"), Chlordiazopoxide (Balance "Yamanouti") and Bellafoline-Ergotamine tartrate-Phenobarbitone-Mixture (Bellergal "Sandoz") were used for the treatment of autonomic dystonia complicated with or without postural hypotension. The subjective improvement can be effectively gained and the III or I type mecholyl-test is often converted into the II or II' as well as the II' type into the II.
- 千葉大学の論文
- 1963-07-28
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