臨床 急性心筋梗塞における末梢循環動態下腿 pneumoplethysmography による観察 重症度及び心血行動態値との関係について
急性心筋梗塞(AMI)の末梢循環につきPneumople thysmographを用い,venous occlusion technicによりcalf blood flow(CBF),calf venous capacitance(CVC),calf vascular resistance(CVR)を測定,健常例と比較した.CBFとCVCは健常群に比し有意に小さく,CVRは有意に高かった.Killip II群はI群に比しCBFが有意に少なく,CVRは有意に高かった.Forresterのsubsetと対比すると,CBF,CVCはH-I～H-IVのすベてで健常群に比し有意に減少し,CVRはH-II...
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| Published in | 心臓 Vol. 12; no. 9; pp. 964 - 972 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
25.09.1980
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.12.9_964 |
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| Abstract | 急性心筋梗塞(AMI)の末梢循環につきPneumople thysmographを用い,venous occlusion technicによりcalf blood flow(CBF),calf venous capacitance(CVC),calf vascular resistance(CVR)を測定,健常例と比較した.CBFとCVCは健常群に比し有意に小さく,CVRは有意に高かった.Killip II群はI群に比しCBFが有意に少なく,CVRは有意に高かった.Forresterのsubsetと対比すると,CBF,CVCはH-I～H-IVのすベてで健常群に比し有意に減少し,CVRはH-IIとH-IVで有意に高値を示した.H-IIとH-IVはH-Iに比し,CBFは有意に少なく,CVRは有意に高かった.Swan Ganzカテーテル法による心血行動態値と対比するに,PCWPとCBFの間にr=-0.37,CVRとの間にr=0.36,中心静脈圧とCBFの間にr=-O.31,総末梢血管抵抗とCVRの間にr=O.43の有意の相関が認められた.CBF低値CVR高値は抵抗血管収縮をCVC低値アは容量血管収縮を示す.抵抗血管は臓器灌流圧を維持するため,重症になるほど強く収縮するのに対し容量血管は静脈還流を増大するため,心不全の有無にかかわらず収縮するが,ある段階にいたると,静脈還流の増大のみでは心拍出量を維持し得ず,あるいは心機能と代償機序のバランスがとれなくなり,心不全をきたすと解釈される. |
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| AbstractList | 急性心筋梗塞(AMI)の末梢循環につきPneumople thysmographを用い,venous occlusion technicによりcalf blood flow(CBF),calf venous capacitance(CVC),calf vascular resistance(CVR)を測定,健常例と比較した.CBFとCVCは健常群に比し有意に小さく,CVRは有意に高かった.Killip II群はI群に比しCBFが有意に少なく,CVRは有意に高かった.Forresterのsubsetと対比すると,CBF,CVCはH-I～H-IVのすベてで健常群に比し有意に減少し,CVRはH-IIとH-IVで有意に高値を示した.H-IIとH-IVはH-Iに比し,CBFは有意に少なく,CVRは有意に高かった.Swan Ganzカテーテル法による心血行動態値と対比するに,PCWPとCBFの間にr=-0.37,CVRとの間にr=0.36,中心静脈圧とCBFの間にr=-O.31,総末梢血管抵抗とCVRの間にr=O.43の有意の相関が認められた.CBF低値CVR高値は抵抗血管収縮をCVC低値アは容量血管収縮を示す.抵抗血管は臓器灌流圧を維持するため,重症になるほど強く収縮するのに対し容量血管は静脈還流を増大するため,心不全の有無にかかわらず収縮するが,ある段階にいたると,静脈還流の増大のみでは心拍出量を維持し得ず,あるいは心機能と代償機序のバランスがとれなくなり,心不全をきたすと解釈される. |
| Author | 高野, 照夫 清野, 精彦 早川, 弘一 大林, 完二 木村, 栄一 赤池, 正博 |
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| References | 19) Brodie, T. G., Russel, A. E.: On the determination of the rate of blood flow. J. Physiol., London, 32: 47, 1905. 33) Vyden, J. K., Sellers, A., Nagasawa, K., Takano, T., Marsha Groseth-Robertson, Swan, H. J. C.: Peripheral hemodynamics in anephric patients with hypertension, Am. Heart. J., 96: 203, 1978. 7) Zelis, R.: The contribution of local factors to the elevated venous tone of congestive heart failure. J. Clin. Invest., 54: 219, 1974. 14) Forrester, J. S., Diamond, M. D., Chatterjee, M. B., Swan, H. J. C.: Medical therapy of acute myocardial infarction by application of hemodynamic subsets. N. Engl. J. Med., 295: 1356, 1976. 24) Zelis, R., Mason, D. T.: Isosorbide Dinitrate. Effect on the vasodilator response to. Nitroglycerin. JAMA, 234: 166, 1975. 8) Zelis, R., Nellis, S. H., Longhurst, J., Mason, D. T.: Abnormalities in the regional circulation acco mpanying congestive heart failure. Frog. Cardiovasc. Dis., 18: 181, 1975. 25) Miller, R. R., Vismara, L. A., Zelis, R.: Clinical use of sodium nitroprusside in chronic ischemic heart disease. Circulation, 51: 328, 1975. 12) Killip, T., Kimball, J. T.: Treatment of myocardial infarction in a coronary care unit, Am. J. Card., 20: 457, 1967. 20) Landowne, M., Katz, L. N.: Critique of plethysmographic method of measuring blood flow inex tremities of man. Am. Heart J., 23: 644. 1942. 23) Taylor, W. R., Forrester, J. S., Magnusson, P., Takano, T., Chatterjee, K., Swan, H. J. C.: Hem o dynamic effects of Nitroglycerin ointment in congestive heart failure. Am. J. Card., 38: 469, 1976. 31) Lippman, H. L., Winsor, T.: Medical instrumentation in peripheral vascular diseases. Circulation, 45: 285, 1975. 17) Mason, D. T., Braunwald, E: A simplified plethysmographic system for the measurement of systemic arterial pressure and peripheral blood flow. Am. Heart. J., 64: 796, 1962. 28) Whitney, R. J.: The measurement of volume changes in human limbs, J. Physiol., 121: 1, 1973. 39) Kramer, R. S., Mason, D. T., Braunwald, E.: Augmented sympathetic neurotransmitter activity in t he peripheral vascular bed of patients with congestive hart failure and cardiac norepinephrine d epletion, Circulation, 38: 629, 1968. 34) Ogawa, T., Vyden, J. K., Rose, H. B., Singh, B. N., Swan, H. J. C.: Peripheral and central hemod ynamics in acute myocardial infarction. VII I World Congress of Cardiology, abstructs-1, 0228, 143, 1978. 1) Mason, D. T. edited: Congestive Heart Failure. Yorke Medical Books, New York, 1976. 37) Hawn, J. A., Rhyneer, G. S., Bristow, J, D.: Forearm blood flow and venous tone in acute myoca r dial infarction. Circulation, 44 (Suppl. ): 11-175, 1971. 40) Mellander, S.: Comparative studies on the adrenergic neuro-hormonal control of resistance and c a pacitance blood vessels in the cat. Acta. Physiol. Scand., 50: (suppl, 176): 1, 1960. 10) Schweitzer, P., Pivouka, M., Kivanova.: The blood flow in the forearm in patients with cardiac failure. Zeitschrift far die Gesamte experimentalle Medizin, 143: 126, 1967. 32) Vydeu, J. K., Nagasawa, K., Groseth-Dittrich, M., Swan, H. J. C.: Peripheral hemodynamics in acute myocardial infarction. Clin. Res., 23: 213A, 1 9 75. 3) Mason, D. T., Braunwald, E.: The effects of nitroglycerin and amyl nitrate on arteriolar and venous tone in the human forearm. Circulation, 32: 755, 1965. 15) Barne, R. W.: Noninvasive diagnostic techniques in peripheral vascular disease. Am. Heart J., 97: 241, 1979. 5) Zelis, R. edited: The peripheral circulation. Clinical Cardiology Monographs, New York, 1975. 4) Zelis, R., Longhurst, J., Capone, R. J., Lee, G., Mason, D. T.: Congestive Heart Failure. ed. by Mason, D. T., Yorke Medical Books, New York, 1976, p. 129. 38) Zelis, R., Mason, D. T.: Diminished forearm arteriolar dilator capacity produced by mineralcorticoid induced salt retention in man, Circulation, 41: 589, 1 9 70. 41)清野精彦, 高野照夫, 大林完二, 他: 急性心筋梗塞における末梢循環および心血行動態に対する各種血管拡張剤の作用について, 第44回日循学会総会講演, 日循学誌, suppl 44(1): 98, 1980. 29) Winsor, T.: The segmental plethsmograph. Angiology, 8: 87, 1957. 9) Zellis, R., Longhurst, J., Capone, R. J., Lee, G.: Peripheral circulatory control mechanisms in congestive heart failure. Am. J. Card., 32: 481, 19 7 3. 36) Lee, G.: Total and peripheral blood flow in acute myocardial infarction, Brit. Heart. J., 19: 117, 1957. 2) Mason, D. T., Braunwald, E.: Studies on digitalis. X. Effects of ouabain on forearm vascular r e sistance and venous tone in normal subjects and in patients in heart failure. J. Clin. Invest., 43: 532, 1964. 35) Abboud, F. M., Schmid, P. G.: Circulatory adjustments to heart failure. Heart Failure ed. by Fish m an, A. P., McGraw-HiLL Book Company, Was h ington, 1978, p. 249. 6) Zelis, R., Mason, D. T., Braunwald, E: A comparison of the effects of vasodilator stimuli on peripheral resistance vessels in normal subjects and in patients with congestive heart failure. J. Clin. Invest., 47: 960, 1968. 22) Conrad, M. C., Green, H. D.: Evaluation of venous occlusion plethysmograph. J. Appl Physiol., 16: 289, 1961. 26) Awan, N. A., Miller, R. R., Maxwell, K., Mason, D. T.: Effects of prazosin on forearm resistance and capacitance vessels. Clin. Pharm. Therap., 22: 79, 1977. 13) Forrester, J. S., Diamond, G. A., Swan, H. J. C.: Correlative classification of clinical and hemodynam ic function after acute myocardial infarction. Am. J. Card., 39: 137, 1977. 21) Formel, P. F., Doyle, J. T.: Rationale of venous occlusion plethysmography. Circ. Res., 5: 1957. 18) Hyman, C., Winsor, T.: The application of the segmental plethysmograph to measurement of blood flow through the limb of human beings, Am. J. Card., 5: 667, 1960. 30) Karpman, H. L., Winsor, T.: The plethysmographic peripheral vascular study. J. International College of Surgens., 30: 425, 1958. 27) Whitney, R. J.: The measurement of the changes in human limb volume by means of a mercury-in-rubber strain gauge. J. Physiol., 109: 5, 1949. 11) Mason, D. T.: Symposium on vasodilator and inotropic therapy of heart failure. Symposium perspectiv e. Am. J. Med., 65: 101, 1978. 16) Holling, H. E., Boland, H. C., Russ, E.: Investigation of arterial obstruction using a mercury-in-rubber strain gauge. Am. Heart J., 62: 194, 1961. |
| References_xml | – reference: 35) Abboud, F. M., Schmid, P. G.: Circulatory adjustments to heart failure. Heart Failure ed. by Fish m an, A. P., McGraw-HiLL Book Company, Was h ington, 1978, p. 249. – reference: 38) Zelis, R., Mason, D. T.: Diminished forearm arteriolar dilator capacity produced by mineralcorticoid induced salt retention in man, Circulation, 41: 589, 1 9 70. – reference: 10) Schweitzer, P., Pivouka, M., Kivanova.: The blood flow in the forearm in patients with cardiac failure. Zeitschrift far die Gesamte experimentalle Medizin, 143: 126, 1967. – reference: 12) Killip, T., Kimball, J. T.: Treatment of myocardial infarction in a coronary care unit, Am. J. Card., 20: 457, 1967. – reference: 13) Forrester, J. S., Diamond, G. A., Swan, H. J. C.: Correlative classification of clinical and hemodynam ic function after acute myocardial infarction. Am. J. Card., 39: 137, 1977. – reference: 17) Mason, D. T., Braunwald, E: A simplified plethysmographic system for the measurement of systemic arterial pressure and peripheral blood flow. Am. Heart. J., 64: 796, 1962. – reference: 21) Formel, P. F., Doyle, J. T.: Rationale of venous occlusion plethysmography. Circ. Res., 5: 1957. – reference: 11) Mason, D. T.: Symposium on vasodilator and inotropic therapy of heart failure. Symposium perspectiv e. Am. J. Med., 65: 101, 1978. – reference: 33) Vyden, J. K., Sellers, A., Nagasawa, K., Takano, T., Marsha Groseth-Robertson, Swan, H. J. C.: Peripheral hemodynamics in anephric patients with hypertension, Am. Heart. J., 96: 203, 1978. – reference: 34) Ogawa, T., Vyden, J. K., Rose, H. B., Singh, B. N., Swan, H. J. C.: Peripheral and central hemod ynamics in acute myocardial infarction. VII I World Congress of Cardiology, abstructs-1, 0228, 143, 1978. – reference: 39) Kramer, R. S., Mason, D. T., Braunwald, E.: Augmented sympathetic neurotransmitter activity in t he peripheral vascular bed of patients with congestive hart failure and cardiac norepinephrine d epletion, Circulation, 38: 629, 1968. – reference: 6) Zelis, R., Mason, D. T., Braunwald, E: A comparison of the effects of vasodilator stimuli on peripheral resistance vessels in normal subjects and in patients with congestive heart failure. J. Clin. Invest., 47: 960, 1968. – reference: 26) Awan, N. A., Miller, R. R., Maxwell, K., Mason, D. T.: Effects of prazosin on forearm resistance and capacitance vessels. Clin. Pharm. Therap., 22: 79, 1977. – reference: 19) Brodie, T. G., Russel, A. E.: On the determination of the rate of blood flow. J. Physiol., London, 32: 47, 1905. – reference: 7) Zelis, R.: The contribution of local factors to the elevated venous tone of congestive heart failure. J. Clin. Invest., 54: 219, 1974. – reference: 16) Holling, H. E., Boland, H. C., Russ, E.: Investigation of arterial obstruction using a mercury-in-rubber strain gauge. Am. Heart J., 62: 194, 1961. – reference: 27) Whitney, R. J.: The measurement of the changes in human limb volume by means of a mercury-in-rubber strain gauge. J. Physiol., 109: 5, 1949. – reference: 20) Landowne, M., Katz, L. N.: Critique of plethysmographic method of measuring blood flow inex tremities of man. Am. Heart J., 23: 644. 1942. – reference: 30) Karpman, H. L., Winsor, T.: The plethysmographic peripheral vascular study. J. International College of Surgens., 30: 425, 1958. – reference: 3) Mason, D. T., Braunwald, E.: The effects of nitroglycerin and amyl nitrate on arteriolar and venous tone in the human forearm. Circulation, 32: 755, 1965. – reference: 4) Zelis, R., Longhurst, J., Capone, R. J., Lee, G., Mason, D. T.: Congestive Heart Failure. ed. by Mason, D. T., Yorke Medical Books, New York, 1976, p. 129. – reference: 14) Forrester, J. S., Diamond, M. D., Chatterjee, M. B., Swan, H. J. C.: Medical therapy of acute myocardial infarction by application of hemodynamic subsets. N. Engl. J. Med., 295: 1356, 1976. – reference: 23) Taylor, W. R., Forrester, J. S., Magnusson, P., Takano, T., Chatterjee, K., Swan, H. J. C.: Hem o dynamic effects of Nitroglycerin ointment in congestive heart failure. Am. J. Card., 38: 469, 1976. – reference: 25) Miller, R. R., Vismara, L. A., Zelis, R.: Clinical use of sodium nitroprusside in chronic ischemic heart disease. Circulation, 51: 328, 1975. – reference: 5) Zelis, R. edited: The peripheral circulation. Clinical Cardiology Monographs, New York, 1975. – reference: 22) Conrad, M. C., Green, H. D.: Evaluation of venous occlusion plethysmograph. J. Appl Physiol., 16: 289, 1961. – reference: 28) Whitney, R. J.: The measurement of volume changes in human limbs, J. Physiol., 121: 1, 1973. – reference: 29) Winsor, T.: The segmental plethsmograph. Angiology, 8: 87, 1957. – reference: 31) Lippman, H. L., Winsor, T.: Medical instrumentation in peripheral vascular diseases. Circulation, 45: 285, 1975. – reference: 2) Mason, D. T., Braunwald, E.: Studies on digitalis. X. Effects of ouabain on forearm vascular r e sistance and venous tone in normal subjects and in patients in heart failure. J. Clin. Invest., 43: 532, 1964. – reference: 40) Mellander, S.: Comparative studies on the adrenergic neuro-hormonal control of resistance and c a pacitance blood vessels in the cat. Acta. Physiol. Scand., 50: (suppl, 176): 1, 1960. – reference: 8) Zelis, R., Nellis, S. H., Longhurst, J., Mason, D. T.: Abnormalities in the regional circulation acco mpanying congestive heart failure. Frog. Cardiovasc. Dis., 18: 181, 1975. – reference: 41)清野精彦, 高野照夫, 大林完二, 他: 急性心筋梗塞における末梢循環および心血行動態に対する各種血管拡張剤の作用について, 第44回日循学会総会講演, 日循学誌, suppl 44(1): 98, 1980. – reference: 9) Zellis, R., Longhurst, J., Capone, R. J., Lee, G.: Peripheral circulatory control mechanisms in congestive heart failure. Am. J. Card., 32: 481, 19 7 3. – reference: 32) Vydeu, J. K., Nagasawa, K., Groseth-Dittrich, M., Swan, H. J. C.: Peripheral hemodynamics in acute myocardial infarction. Clin. Res., 23: 213A, 1 9 75. – reference: 37) Hawn, J. A., Rhyneer, G. S., Bristow, J, D.: Forearm blood flow and venous tone in acute myoca r dial infarction. Circulation, 44 (Suppl. ): 11-175, 1971. – reference: 1) Mason, D. T. edited: Congestive Heart Failure. Yorke Medical Books, New York, 1976. – reference: 24) Zelis, R., Mason, D. T.: Isosorbide Dinitrate. Effect on the vasodilator response to. Nitroglycerin. JAMA, 234: 166, 1975. – reference: 36) Lee, G.: Total and peripheral blood flow in acute myocardial infarction, Brit. Heart. J., 19: 117, 1957. – reference: 15) Barne, R. W.: Noninvasive diagnostic techniques in peripheral vascular disease. Am. Heart J., 97: 241, 1979. – reference: 18) Hyman, C., Winsor, T.: The application of the segmental plethysmograph to measurement of blood flow through the limb of human beings, Am. J. Card., 5: 667, 1960. |
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| Snippet | 急性心筋梗塞(AMI)の末梢循環につきPneumople thysmographを用い,venous occlusion technicによりcalf blood flow(CBF),calf venous capacitance(CVC),calf vascular... |
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| SubjectTerms | 宋梢循環動態 急性心筋梗塞 |
| Subtitle | 重症度及び心血行動態値との関係について |
| Title | 臨床 急性心筋梗塞における末梢循環動態下腿 pneumoplethysmography による観察 |
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