肺動脈のEky分析,とくに,前肺毛細管性障害による肺高血圧を考慮して
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Since these four years similarity in contour between electrokymographic curve [CEky (f)] and pressure wave in the region of the pulmonary arterial knob has been investigated in a large number of subjects in comparison with their hemodynamics obtained by these curves. In this paper, in reference to the right ventricular dynamic values (O. Bayer's method) obtained by right heartcathe terization, the following possibilities were examined : (1) whether the right ventricular dynamic values can be determined non-surgically from Eky (f) and (2) whether pulmonary hypertension can be detected in cases of precapillary lesions which are chiefly due to obstructive ventilatory disturbances. Eky (f) was recorded with Elema's apparatus. The pulmonary arterial pressure was measured with Sanborn Straingage-transducer-manometer system. Cardirex 6 (Siemens) was also used for recording of Eky (f). The studies were performed on 22 normal subjects, 30 cases of precapillary lesions and 21 cases postcapillary lesions; on 30 of total 73 cases cardiodynamic analysis (O. Bayer) was performed. Fig. 1 illustrates a method by which the right ventricular dynamic values are obtained from actual recordings of Eky (f) and pulmonary arterial pressure wave. Right ventricular dynamic values are taken in the ordinate and height of pulmonary arterial pressure wave, in the abscissa in Fig. 5. Distribution of the transformation period (UFZ') and the rising pressure period (DAZ') of the right ventricle'was found somewhat wide, but these dynamic values were scattered roughly on the vicinity of 45° line. The spontaneous fluctuation of the right ventricular dynamic values at 3', 10', and 15' were examined on 10 cases of pre- and postcapillary lesions as shown in Fig. 23 and 24. The variation index of UFZ' and DAZ' was found relatively large, whereas the tension period (ASZ') and the ejection period (ATZ') of the right ventricle showed the variation index within ±10%.Therefore the trial of the non-surgical measurement of the right ventricular dynamic values by Eky (f) may be, to a certain extent, possible and may be regarded as a supplementary method for the observation on the course of the disease, i. e. "Langsbeobachtung". Further practice in the actual measurement was shown in Fig. 26 ; height of summit, incisura and dicrotic wave in the curve were designated as h_1, h_2, and h_3 respectively. The measurement was made in 16 normal subjects, 17 cases of precapillary lesions without pulmonary hypertension and 19 cases of precapillary lesions with pulmonary hypertension. The right ventricular dynamic values by Eky (f) were shown in Fig. 27 and 28. In the pulmonary hypertensive group, UFZ' and ASZ' were prolonged, whereas ATZ' was shortened. In the group without pulmonary hypertension, ASZ' was shorter than 130 msec, in most cases. In Fig. 30, tension and ejection periods of right and left ventricles were compared together. The difference between ASZ' and ASZ was found larger in the pulmonary hypertensive group than in the other groups, while the difference between ATZ' and ATZ was smaller in the former group than in the latter group. A ratio of ATZ' to ASZ' (ATZ'/ASZ') was always larger than 2.0 in the group free from pulmonary hypertension (Fig. 29). Therefore it seemed confirmed that the same mode of the pressure reaction observed by Blumberger in the left ventricle could also occur in the right ventricle under the pulmonary hypertension. Fig. 31 shows a time-interval between the summit of the curve and the second heart sound. In most cases of the pulmonary hypertension, the summit of the curve appeared within 30 msec, before the second heart sound or it was superimposed on the second heart sound. Ratios of the height of incisura or of dicrotic wave to the maximal amplitude of the curve were shown in Fig. 32. The ratio of the former was more than 0.75 in most cases of the pulmonary hypertension.The ratio of the latter tended to become smaller in the pulmonary hypertensive group. Moreover the dicrotic wave sometimes disappeared completely. The configuration of Eky (f) and hemodynamic values obtained were compared between the pulmonary hypertensive group and normal health (Fig. 33). Summarizing the results, it may be concluded that under the following conditions, pulmonary hypertension complicated with precapillary lesions seems highly suggestive though some exceptions are noted ; 1. when the summit of the curve appears within 30 msec, before the second heart sound, or superimposed on it, 2. when the incisura is highly elevated or completely disappeared, 3. when the dicrotic wave disappears. 4. when the difference of the tension period between the left and right ventricles gets larger than 30 msec., 5. when the tension period of the right ventricle is longer than 130 msec., 6. when the ratio of ATZ' to ASZ' is less than 2.0. In Tab. 6, the above five electrokymographic characteristics of the pulmonary hypertension were shown as well as the scores calculated according to these five characteristics in each case. Those cases which satisfied more than two of these 'characteristics, showed always the pulmonary hypertension. However, three pulmonary hypertensive patients were found in 34 cases which missed completely these five characteristics. Various sorts of changes in Eky (f) occurred in pulmonary hypertension. Those changes showed a tendency to become more marked in the precapillary lesions than in the postcapillary lesions under the same pulmonary arterial blood pressure level. These patients who satisfy more than three of these five characteristics can strongly suggest the presence of the pulmonary hypertension complicated with the precapillary disorders due to obstructive ventilatory disturbances.
- 千葉大学の論文
- 1965-07-28