多相性脈波分析によるBallistocardiogramの診断学的価値の検討
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The peripheral vascular factors are thought to relate dominantly to the IJ deflection, of Bcg. However, the cardiac factors also should not be neglected. In order to clarify this problem, cardiovascular dynamical analyses were performed. simultaneously by the methods of Wezler, Blumberger and Holldack, and vectorial Bcg. Methods Starr's high frequency Bcg of the horizontal, two directional type i. e. head-foot and left-right directions was used for the qualitative and semi-quantitative studies. This Bcg was standerdized by the Committee on Ballistocardiographic Terminology in U. S. A. (1956). Pcg., Ecg., carotid and femoral arterial pulse waves and respiratory curve were recorded simultaneously. The Bcgraphic findings were compared with the cardio-vascular dynamics obtained by Wezler, Blumberger and Holldack's methods as well as the X-ray kymographic and electrokymographic findings. A. Qualitative observation of Bcg based on Brown's classification. A lot of descriptions were published about the qualitative changes in Bcg in various heart disease. However, the pathognomonic changes are not yet well established for each disease. The abnormalities in Bcg-waves were classified into 4 grades by Herbert Brown. A-1. The materials were 70 subjects of normal health, 160 cases of hypertension, 53 cases of coronary diseases, 12 cases of aortic valvular disorders and 22 cases of mitral valvular diseases. Those 317 subjects were classified by Brown's definition. 86.8% of coronary diseases with due regards to the age of patients showed the definitely abnormal findings. The Brown IV grade was noted in 30.2%, while the Brown IV grade was noted only in 6.3% of hypertension. Many of the patients with aortic valvular diseases showed the Brown O to I grade. The Brown II to III grade was increased in number in mitral valvular diseases. Two coronary patients of the Brown III and IV grade died suddenly during hospitalization in our clinic. Autopsy findings confirmed marked coronary and myocardial lesions. Thus, abnormality in the Brown's classification seems to have some characteristics in various cardiac diseases. The Brown's classification may reveal pathologic conditions of the underlying disease as well as prognosis of it. A-2 Administration of coronary dilators or recent depressant drugs could not alter the grade of the Brown's classification, though subjective and objective improvements were clinically recognized. The proper use of digitalis glycosides improved the grade of the Brown's classification. A-3. Severity of Ecg myocardial disturbances and the grade of Brown's classification were compared in arterial hypertension. No definite correlation was found, though the patients with severely abnormal Ecg could not show the Brown O to I grade. A-4. Compared the grade of Brown's classification with cardiovascular dynamics in arterial hypertension, the cases of the Brown IV grade indicated the distinct increase in W and E' and slight increase in bood pressure with more decrease in Vs. However, no more significant changes in Vm and ATZ/ASZ were noted in these cases than others. The group of the Brown III grade, as compared with the less severe groups, showed no significant change in the circulatory dynamics. B. The critical study upon the IJ deflection in the Head-Foot Bcg. The IJ deflection had an importance not only in the quantitative analysis, but also in semi-quantitative or qualitative analysis. The cardio-vascular dynamic observations were analyzed in relation to the IJ deflection. The IJ deflection was largely affected by age, heart rate and hemodynamic situations. Influences of the heart rate on the IJ deflection were critically studied, of which results revealed that correction of the IJ deflection by the heart rate, IJc (PR×IJ), might be necessary. B-1. Relationship between the IJ deflection and hemodynamics. was examined in 50 subjects of normal and in 90 cases of arterial hypertension. The IJ deflection seemed to have correlation to W, E' and diastolic pressure, excepting Vs and Pm. This observation may support a concept that the IJ deflection in normal health and in arterial hypertension may be influenced by vascular factors. B-2. Taking the hemodynamic behavior and age into consideration, the corrected IJc was determined in arterial hypertension. Among N (normal), W and W+E' types, a marked difference of IJc was noted between patients younger than 39 years of age and older than 40 years of age. IJc in M type was small andnotrelated to age. No definite correlationship could not be seen in the E' type. IJc of valvular diseases was correlated to Vm. The same tendency was obtained by corrected Vbc, i. e. the corrected velocity of the body displacement Vb. B-3. Stumpf's X-ray kymographic classification and IJc were investigated in arterial hypertension. IJc of the cases of Stump f's II type was less than that of Stump f's I type in juvenile, middle-aged and senile hypertension. The cases of Stumpf's II type in middle aged and senile hypertension showed the definitely small IJc deflection. The cases of Stumf's I type in juvenile hypertension showed the fairly large IJc deflection. The IJc in arterial, hypertension seemed to have close relationship to Stump f's types. B-4. IJ may be one of the good indicators to cardio-vascular function. As mentioned above, IJ seems to be more gravely affected by vascular factors in arterial hypertension which is free from valvular disorders. In mitral and aortic valvular diseases, IJ seems to affected much more by cardiac factors. C. The vectorial analysis of Bcg with special reference to the transeverse deflection. The methods for the vectorial analysis are yet unsatisfactory. The present work indicated of the vectorial analyses for the transverse deflection of ballistic movement. C-1. By horizontal vectorial analysis of Bcg, the maximal vector J^^^ was obtained. Its angle was denoted by αJ^^^. The area of the J vector loop above the abscissa was named a^^^J. a^^^J/J^^^ implied a mean value of the transverse deflection. This simple procedure made it possible to clarify the unknown difference of ballistic movements in various cardiac diseases and to characterize the peculiarity of underlying diseases. The large longitudinal deflection of Asl and the large transverse deflection of MS were an excelent example. In arterial hypertension, the W+E' type showed decreased a^^^J (decrease length and breadth). The M type showed marked increased both transverse and longitudinal deflection than the W+E' type. Increased transverse deflection in the M type suggested that relative Ms might be contributory to this phenomenon. αJ^^^ of normal health and aortic disorders was in the 1st quadrant and that of mitral disorders was in the 2nd quadrant, αJ^^^ of arterial hypertension was in the 1st and/or 2nd quadrant. C-2. The above specific findings in the aortic insufficiency and mitral stenosis were analyzed with those of Eky and X-ray kymography. The hemodynamic bases of the argumention of either longitudinal or transverse directions were discussed.
- 千葉大学の論文
- 1964-11-28