超小型圧変換器による肺動脈圧波の研究 : とくに,右室力学的数値とFourier解析を中心として
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概要
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The pressure wave curves indirectly obtained by the manometer system heretofore in clinical use have not always proven to give exact measurements, because of various sorts of electrotonic as well as hemodynamic deficiencies. As recently our collaborators have completed the trial stage of the intravascular microphono-manometer with semiconductor transducer gauge as well as its precise calibration, it has enabled in our laboratory to perform the direct phono-manometry free from various sorts of the difficulties hitherto in discussion. Therefore, some of the data on the cardio-vascular dynamical analysis already published from our laboratory have stood in need of making amendments. 1. The arterial pressure waves of nineteen subjects with or without cardio-pulmonary diseases were simultaneously repeated to register intravascularly by the micromanometer with the semiconductor gauge achieved by us as well as extracorporally by P 23 Db Sthatham transducer. 2. The pulmonary arterial (PA) pressure waves obtained by our intracorporal microtransducer showed definitely less artefacts and displayed the exact reemergence on each of the segments through the cardiac period. 3. The cardiodynamical values of the right ventricle were measured by O. Bayer's method and investigated by Fourier-Bessel's analysis. 4. The "Vorwellen" (v. Hurthle) of PA pressure waves recorded by our micromanometer have been observed nearly at the rate of 90%, so that it has become more easily possible to measure the cardio-vascular dynamical values of the right heart in the light of O. Bayer's principle. 5. The right ventriculo-dynamical values gained by our intracorporal transducer displayed the general tendency to become less than those by the extracorporal transducers heretofore in use, but this tendency was not always of the same degree with respect to each of the segments of the cardiac period. 6. Among most of the cases, there was diminished the tension time (Ansspannungszeit ASZO with the increase in the cardiac output, prolonged the pressure rising time (Druckanstiegszeit DAZ') with the elevation of the mean PA pressure level, augmented the ejection time (Austreibungszeit ATZ') with the increase in cardiac output and shortened ATZ; with the rise of the mean PA pressure level. 7. By means of our microtransducer, there could also be seen the tendency that ASZ' was decreased and ATZ' increased, as the preceding cardiac period was prolonged in the right ventriculo-dynamical values of the patients with atrial fibrillation. 8. The amplitudes of the harmonics analysed by Fourier-Bessel's method tended to be observed less and less as the harmonic number became larger and larger, though there existed a few exceptions to this mode of changes in individual cases here described. 9. The starting phase angles grew little by little towards the distal direction of the respective pulmonary artery. In the main stem and branch of the pulmonary artery, the starting phase angle were gradually reduced up to the 3rd harmonic. But, concerning the occasion with higher frequency component, there failed such a definite mode of change as above mentioned. In the distal portion of the respective pulmonary artery, there was again found, as a rule, the tendency of the starting phase angles gradually to decrease. 10. The maximal rate of the modulation in pulmonary arterial pressure waves were seen in the increasing stage of the 1st to 6th harmonic. The maximal level of pulmonary arterial waves consisted chiefly of the 1st, 2nd and 3rd harmonics. In the latter half of the diastole, the 1st and 2nd harmonics took almost the same share as that of the 3rd regarding the composition of the pressure wave level. 11. Among the subjects with so-called Hurthle's peaking phenomenon the maximal rate of the change in the pressure level was seen in the distal area, while among those without this phenomenon it was seen in the proximal area of the pulmonary artery. 12. The accerelated apparent phase velocity were observed in precapillary disorders, whereas among postcapillary patients there existed just opposite relationship. 13. Roughly speaking, the group velocity at the incisura of the pulmonary arterial pressure waves tended to show the accerelation and at their diastolic limbs it tended to become slow, though there existed some exception with this mode of the tendency in individual cases. As the pressure reaction in the sense of Blumberger and the mean PA pressure were increased in their extent, the group velocity at the incisura tended to be accerelated.
- 千葉大学の論文