頸動脈波曲線における"Spatsystolischer Buckel"の診断的意義
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概要
- 論文の詳細を見る
By means of Cardirex 6 (Siemens) fitted with "Infraton-Abnehmer" or the electromagnetic oscillograph fitted with beryllium membrane manometer, 505 carotid volume pulse waves were recorded in 340 subjects for analyses of the late systolic hump appearing in the later half of systolic phase of carotid pulse wave, with special reference to its origin and diagnostic meaning. The shape of carotid pulse wave was divided into five types by the contour of the late systolic hump, i. e, O, I , II, III and IV. The late systolic hump was observed in all normal subjects. The juveniles showed more frequently the clear-cut late systolic hump in the left carotid pulse wave than in the right one. The middle-aged and old subjects, however, did not indicate such a marked difference in the late systolic hump that depends on the recording side. The first type of the late systolic hump was, in general, often observed in normal subjects, patients with essential hypotension, mitral and aortic valvular diseases and high output disorders, among which high output disorders showed the first type most strikingly. The third as well as fourth types were frequently found in arterial hypertension. In the normal juvenile subjects and in patients other than the hypertensives the first type was observed most frequently and the advanced types (III, IV) were increased with age. This advancing of the type with aging was also noted in arterial hypertension though there existed a difference of the extent of changes between normal subjects and hypertensives. While normal subjects with the first and second types showed usually the normal cardiodynamical reaction in the sense of Blumberger, the third and fourth types revealed the tendency to pressure reaction. In the first and second types, the vasculodynamical values obtained from Wezler's method showed the normal type in majority of the cases. On the contrary, in the third and fourth types the vasculodynamical values indicated "Anspannungstyps" (Duesberg & Schroeder) in majority. With the advancing, in types from I to IV mean values of systolic and diastolic pressures, peripheral vascular streaming resistance, vascular volume elastisity coefficient and pulse wave velocity of the arterial "Windkessel" were increased, while the stroke and minute volumes were decreased both in normal subjects and arterial hypertension. However, there existed a difference of extent of these changes in hemodynamics between normal subjects and patients with arterial hypertension. In atrial fibrillation appearance of the late systolic hump seemed to be depending on a preceding cardiac cycle length. When the preceding cycle length was very short, the late systolic hump often disappeared. Among the three small waves observed on the systolic portion of the carotid pulse wave, the third wave was shifted backward with the prolongation of the preceding cardiac cycle length. The late systolic hump became more marked in the "Anspannungstyps" obtained by norepinephrine injection. When the "Entspannungstyps" (Duesberg & Schroeder) was elicited by the injection of epinephrine, the late systolic hump decreased in its magnitude. By the depressant drug therapy for arterial hypertension, the change in the contour of the late systolic hump occured in the direction from IV to III, II and I. On this occasion, peripheral vascular streaming resistance and vascular volume elastisity coefficient tended to be diminished without any definite change in the stroke volume. No parallelism of the mode of changes was noted between the amplitude of the late systolic hump and that of the dicrotic wave. Therefore, it may be safe to say that a reflexion theory will not fully explain the origin of the late systolic hump.
- 千葉大学の論文
- 1966-01-28