運動負荷試験による循環機能の評価について
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概要
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1. In order to examine the changes in parameters indicative of cardiac reserve and to investigate Wezler's "Physiologische Altersinsuffizienz", there were performed exercise tests by the ergometers of the treadmill type besides the pedal type designed by our collaborators Yaguchi et al (published at the Vth General Assembly of the Japanese M. E. Society in July, 1966) in the normal juvenile as well as senile, sportsmen and cardiac patients with relative compensation at rest, totally in 57 subjects. 2. There exists no clear-cut difference in the cardiac volume estimated by Rohrer-Kahlstorf's formula between the normal juvenile and senile, except that the upper limit in the latter exceeds somewhat to that in the former. While the mean cardiac volume of sportsmen ranks at the upper limit in normal control, most of the cardiac patients with relative compensation show the cardiac volume within the normal range. The ratio of cardiac volume to body weight were determined larger among the normal senile and cardiac patients than the normal juvenile and sportsmen on an average. 3. As to heart rates at rest, the sportsman group has a marked tendency to bradycardia. In comparison with the effects of the load of 50 watt on heart rates in each group, extent of the increase in heart rates was found less marked in the normal senile than the normal juvenile ; this tendency was quite distinct in the sportsman group. On the whole, the change in heart rates appears to be inversely relative to the cardiac volume among the normal juvenile and sportsmen, though there can not be found any significant correlation. The increase in heart rates at the maximal ergostasis according to Reindell was smaller in the cardiac patients than in other three groups ; there existed, however, no significant difference among these four groups discussed here. The heart rates in the maximal ergostasis was inversely relative to the cardiac volume in the normal senile and sportsmen ; above all, there was found the significant correlation in the former group. 4. The oxygen uptake per body surface area at the load of 50 watt was equal in its amount among all the groups. The oxygen uptake per body surface area at the maximal ergostasis was larger in the sportsman group than in the normal juvenile (below 1 per cent level of significance), whereas it was smaller among the cardiac patients than the normal juvenile (below 5 per cent level of significance). There existed no significant correlation between the oxygen uptake and cardiac volume at the maximal ergostasis. 5. The oxygen pulse according to Reindell per body surface area at the load of 50 watt was seen larger among the sportsmen than the other groups. The oxygen pulse at the maximal ergostasis was also found markedly larger among the sportsmen ; it decreased in its amount in the order of the normal juvenile, normal senile and the cardiac patients. Respecting the oxygen pulse per body surface area, the similar tendency was also seen ; its significant increase was, however, only in the sportsman group as compared with the normal juvenile. The cardiac volume appears to be directly relative to the oxygen pulse at the maximal ergostasis among the normal juvenile and senile; there exists the significant correlation in the former. 6. The ratio of "Herzvolumenleistungsquotient" according to Reindell was 58.4±11.3 in the normal juvenile. This value was found larger in the normal senile below 5 per cent level of significance and among the cardiac patients below 0.1 per cent level of significance than in the normal juvenile, whereas this value was found smaller in the sportsman group below 0.1 per cent level of significance than in the normal juvenile. On the other hand, the "Herzvolumenleistungsquotient" in the normal senile sometimes exceeded the normal limit of this value in the normal juvenile. This finding may suggest an evidence of the decrease in circulatory reserve in the normal senile. Since the "Herzvolumenleistungsquotient" shows the significant difference in each of the groups, it may be supposed that the cardiac reserve can be designated in order of decreasing amount as sportsmen, normal juvenile, normal senile and the clinical or subclinical cardiac patients. The extent of pulmonary dysfunction, anaemia and so on must be, however, duly considered for the estimation of factors in cardiac reserve whenever the quotient mentioned above is applied. 7. The vetilatory equivalent at the submaximal as well as maximal ergostasis was seen larger in the normal senile than in the normal juvenile. This reduction of the respiratory efficiency in the normal senile may be due to the decrease in per cent vital capacity, the increase in functional dead space and the diminution of diffusing capacity. 8. Vasculo-dynamically, in the normal senile over 60 years of age there could be found, more or less, the functional as well as organic rigidity of the aortic compression chamber and the low cardiac output, but it is sorry to fail to assure of the decrease in the relative ejection period according to Wezler. 9. Next, the relationship between the "Herzvolumenleistungsquotient" and the pulse wave velocity in the aortic wind-kessel as well as the vascular volume elasticity coefficient was examined. In the normal senile, when the "Herzvolumenleistungsquotient" is found large, both pulse wave velocity and volume elasticity coefficient also tend to be seen large ; there can not, however, be seen such a relationship concerning the peripheral vascular streaming resistance. 10. The cardiac dynamical values at rest remained almost within the normal range in the groups observed here, even in the normal senile. 11. The cardiac dynamical values in the normal seniles, in which "Herzvolumenleistungsquotient" were larger than 70, were compared with those who were smaller than 70 in "Herzvolumenleistungsquotient". The tendency to tachycardia and to "Druckreaktion" in the sense of Blumberger were more often seen in the former group. To speak the individual case, many cases in the former group showed, however, the cardiac dynamical values within normal range, and the wide overlapping of these values could be found between two groups. Accordingly there can not readily be agreed on Lang's opinion that the "Druckreaktion" at rest suggests the existence of the latent heart insufficiency in the normal senile.
- 千葉大学の論文
- 1967-01-28