循環器学におけるMEの応用 : 前編 定量負荷型Ergometerの試作,および,特性測定 : 後編 心内圧,心音Microtransducerの試作,および,特性測定
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概要
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Part I. The Quantitative Electroergometer of the Constant Work Load A. The manufacture of a quantitative loading ergometer for trial and its calibration. In order to study the quantitative evaluation and precise reemergence of exercise tests, above all, among cardiac patients, quantitative exercise ergometer (type A and B) used the direct-current generator was manufactured for trial. The exercise work load was able to put at will ranging from 25 to 200W, and as far as the pedal rate is concerned between 55 to 70 rpm, the work load previously estimated showed only within ±5% of fluctuation. By the type B, better reformed than that of the type A as the result of setting the transmission gear into the feed-back system, the pedal rate ranging from 50 to 80 rpm of the work load previously estimated. B. ReindelPs maximal ergostasis was gained by means of the type A in normal health and cardiac diseases, then some of cardiodynamical values were measured before and after the exercise test. 1) The change in QII, QT, ASZ, ATZ, and ATZ/ASZ were examined in normal before and at 30 to 45 seconds after the max. ergostasis. QII, QT, and ATZ were much influenced according to the rate of cardiac beats, so that the normal range was determined by the recurrent analysis as regards plottings of RR interval measured at the recumbent calm state of 150 cases in normal health. After the exercise test, a good many of QII and ATZ were found in lower limits of the normal range, roughly with proportion to the marked diminuation of RR length. On the other hand, taking account the RR-QT relationship, either diminution or prolongation of QT was seen nearly fifty to fifty. The mode of all of the cases tended to show the pressure reaction in the sense of Blumberger. On this occasion, it was discussed whether the formula obtained from the resting recumbent values could be also applied to that after the exercise. 2) In order to standardize the work load rate, the work load was imposed up to the maximal ergostasis, then cardiodynamical values was examined after the load. Owing to circumstance in our laboratory some of these values were, however, measured at about 30 seconds after the end of exercise, so that the time-relationship were not always absolute uniformally observed. From this wants the careful notice was paid to the judgement of the individual difference in the recovery process. Even though the maximal ergostasis itself according to Reindell et al can still be supposed to hold sufficiently important meanings, it may be necessary simultaneously to examine the cardiovascular dynamical values, for example, in the light of Wezler, Blumberger, or Holldack. 3) The typical changes in cardio-vascular dynamical values were explained in several test cases. The work load rate of the maximal ergostasis imposed by our newly designed ergometer resulted in either "pressure" or "volume" reaction in the sense of Blumberger: in the latter case there could be not rarely seen some marked tachycardia. C. By the use of type B, a certain difference was proven to exist between the work load imposed in the crank and in the crank shaft. When the work load was put on the crank or crank shaft, the increasing rate of heart beats was found larger by the latter procedure than the former. D. With due consideration to the standardization of the ergometry proposed in the International Committee on the Ergometries, 1966, Hannover, the length of the crank and some of other fundamental problems were discussed. Part II. The Microtransducer for the Intracorporal Phono-manometer A. Two sorts of the microtransducers with semiconductor strain gauge were manufactured for trial in oder to study intracardiac manometry as well as phonometry including the analysis of the blood sample simultaneously obtained. The chief aims of this research consist in first, the further development of the idea of late Prof. Yamakawa, one of our valuable advisers, secondly the improvement of the apparatus presented by Prof. Soulie et al and lastly the precise calibration which remains, as a rule, not fully elucidated owing to problem of patent and so on. Respecting the third item our collaborators are all much obliged to the kind assistance of Prof. Yasuda and their co-workers in the Tokyo Institute of Technology and Mr. Ohse in the Nippon Kohden Research Department. These microtransducers (type A and B) were attached to the tip of the double lumen catheter of 8. 5 F. The blood sampling and pressure measurement were performed by the side-hole of the catheter. B. A special apparatus for the relative calibration of these microtransducers was manufactured for trial in oder to assure of the frequency characteristics and sound pressure sensitivity. C. The sensitivity of the type A to the hydrostatic pressure was proven that when 1.3v of direct current was put on the bridge circuit, 0.13mv corresponded to 10mmHg, and that the lineality of the hydrostatic pressure was satisfactorily maintained ranging from 0 to 200mmHg. Though the characteristics of the temperature compensation remained not sufficiently free from completion. The frequency characteristics ranging 20 to 1000 cps. was found almost fiat and the sensitivity to sound pressure was determined -156.5dB. The sensitivity of the type B to hydrostatic pressure was proven that when 3v of direct-current was put on the bridge circuit, 0.4mv corresponded to 10mmHg, and the lineality for the hydrostatic pressure was satisfactory maintained between 0 and 200 mmHg. The frequency characteristics was found almost flat ranging from 20 to 1000 cps and the sensitivity to sound pressure was measured -150dB. While the characteristics of temperatur compensation of this type was more satisfactorily improved than that of the type A, the blood pressure measurement by the former remained still intricate in praxis by the latter. D. The pressure pulse waves recorded by these microtransducers showed generally speaking, more rapid upstrokes than those recorded by extracorporal transducers heretofore in use, and the intracardiac records were far free from interference of displacement due to various sorts of artefacts seen not rarely in the extracorporal. When cardiac murmurs were determined by the intracardiac phonometry, their localization was usually also very precisely orientated. E. The transmission mode of pressure waves in the catheter manometer system was analysed by means of the theory of the "distributed system ". F. Merits and demerits of the microtransducers hitherto presented were discussed and compared those of our newly designed microtransducers, in addition, the intermediate report on the measurement of frequency and intensity distribution of intracardiac sounds, though not yet completed, was supplementarily described.
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