研究会 第23回 河口湖心臓討論会 虚血性心筋障害 心筋虚血における冠血管抵抗の調節部位
冠動脈は灌流圧の低下に対し冠血管抵抗を減少して血流量を維持する。このような調節は微小血管のどの部位において為されるか,さらに心筋虚血に至るまで灌流圧が低下した場合,冠微小血管はどのような反応を示すかは知られていない.これらの検討を目的とし,(1)冠灌流圧低下時の冠細小動脈の管径変化をイヌの左室心筋にて拍動下に計測した.また,心筋虚血に陥りやすい疾患として高血圧症が知られている事より,(2)慢性高血圧症が冠微小血管の抵抗分布に及ぼす影響を,抵抗の調節部位を中心として,ネコを用いた微小血管内圧の直接測定法に依り検討した.その結果,心筋血流量の維持される範囲内で冠灌流圧を下げた時(59±2mmHg)...
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| Published in | 心臓 Vol. 22; no. 3; pp. 318 - 328 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
1990
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| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.22.3_318 |
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| Abstract | 冠動脈は灌流圧の低下に対し冠血管抵抗を減少して血流量を維持する。このような調節は微小血管のどの部位において為されるか,さらに心筋虚血に至るまで灌流圧が低下した場合,冠微小血管はどのような反応を示すかは知られていない.これらの検討を目的とし,(1)冠灌流圧低下時の冠細小動脈の管径変化をイヌの左室心筋にて拍動下に計測した.また,心筋虚血に陥りやすい疾患として高血圧症が知られている事より,(2)慢性高血圧症が冠微小血管の抵抗分布に及ぼす影響を,抵抗の調節部位を中心として,ネコを用いた微小血管内圧の直接測定法に依り検討した.その結果,心筋血流量の維持される範囲内で冠灌流圧を下げた時(59±2mmHg),約100μm以下の細小動脈のみに管径の拡張が認められ,これより上流の小動脈径は不変であった.さらに虚血が起こるまで,冠灌流圧を下げた場合(38±lmmHg),100μm以下の細小動脈の拡張と同時に,これより上流の小動脈に収縮が認められた.ニトログリセリンの投与は,このような小動脈の収縮を緩和せしめた.慢性高血圧においては,対照群に比し約150μm以下の細小動脈のみに,著明な血管抵抗の増加が認められた.これらの結果より以下の結論を得た.(1)冠灌流圧の低下に対し100μm以下の細小動脈の拡張により血流量は維持される.(2)著明な冠灌流圧の低下時には,これらの細小動脈の拡張と同時に,100μm以上の小動脈は最大拡張に至らずに収縮する.(3)慢性高血圧症においては,冠血流量の維持に重要な部位を含む150μm以下の細小動脈のみに著明な抵抗の増加を認め,虚壷に陥りやすい一因と考えられた. |
|---|---|
| AbstractList | 冠動脈は灌流圧の低下に対し冠血管抵抗を減少して血流量を維持する。このような調節は微小血管のどの部位において為されるか,さらに心筋虚血に至るまで灌流圧が低下した場合,冠微小血管はどのような反応を示すかは知られていない.これらの検討を目的とし,(1)冠灌流圧低下時の冠細小動脈の管径変化をイヌの左室心筋にて拍動下に計測した.また,心筋虚血に陥りやすい疾患として高血圧症が知られている事より,(2)慢性高血圧症が冠微小血管の抵抗分布に及ぼす影響を,抵抗の調節部位を中心として,ネコを用いた微小血管内圧の直接測定法に依り検討した.その結果,心筋血流量の維持される範囲内で冠灌流圧を下げた時(59±2mmHg),約100μm以下の細小動脈のみに管径の拡張が認められ,これより上流の小動脈径は不変であった.さらに虚血が起こるまで,冠灌流圧を下げた場合(38±lmmHg),100μm以下の細小動脈の拡張と同時に,これより上流の小動脈に収縮が認められた.ニトログリセリンの投与は,このような小動脈の収縮を緩和せしめた.慢性高血圧においては,対照群に比し約150μm以下の細小動脈のみに,著明な血管抵抗の増加が認められた.これらの結果より以下の結論を得た.(1)冠灌流圧の低下に対し100μm以下の細小動脈の拡張により血流量は維持される.(2)著明な冠灌流圧の低下時には,これらの細小動脈の拡張と同時に,100μm以上の小動脈は最大拡張に至らずに収縮する.(3)慢性高血圧症においては,冠血流量の維持に重要な部位を含む150μm以下の細小動脈のみに著明な抵抗の増加を認め,虚壷に陥りやすい一因と考えられた. |
| Author | 金塚, 完 滝島, 任 |
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| References | 17) Ashikawa, K., Kanatsuka, H., Suzuki, T. and Takishima, T.: Phasic blood flow velocity pattern in epimyocardial microvessels in the beating canine left ventricle. Circ. Res., 59 704, 1986. 6) Page, I. H.: The production of persistent arterial hypertension by cellophane perinephr it is. Jour. AMA., 2: 2046, 1939. 19) Lamping, K. G., Kanatsuka, H., Eastham, C. L., Chilian, W. M. and Marcus, M. L. Non-unifo r m vasomotor responses of the coronary microcirculation to serotonin and vasopressin. Circ. Res., (in press). 15) Feigel, E. O., Buffington, C. W. and Natham, H. J.: Adrenergic coronary vasoconstriction during myocardial underperfusion. Circulation, 75(Suppl. 1): 1, 1987. 8) Rouleau, J., Boerboom, L. E., Surjadhara, A. and Hoffman, J. I. E.: The role of autoregulatio n and tissue diastolic pressure in the transmural distribution of left ventricular bloo d flow in anesthetized dogs. Circ. Res., 45: 804, 1979. 7) Chilian, W. M., Eastham, C. L. and Marcus, M. L.: Microvascular distribution of coronary vascular resistance in the beating left ventricle. Am. J. Physiol., 251: H 779, 1986. 5) Nellis, S. H., Liedtke, A. J. and Whitesell, L.: Small coronary vessel pressure and diameter in an intact beating rabbit heart using fixed-position and free motion techniques. Circ. Res., 49: 1202, 1981. 11) Messina, L. M., Hanley, F. L., Uhlig, P. N., Bear, R. W., Grattan, H. T. and Hoffman, J. I. E.: Effects of pressure gradients between bran c hes of the left coronary artery on the press u re axis intercepts and the shape of steady statec ircumflex pressure-flow relations in the dog. Circ. Res., 58: 11, 1985. 20) Isoyama, S., Sato, F. and Takishima, T.: Normalization of impaired coronary autore g ulation, decreased flow reserve and diminished hyperemic response in hypertrophied rat heat. (submited to Hypertension. 2) Dole, W. P.: Autoregulation of the coronary circulation. Prog. Cardiovasc. Dis., 24: 293, 1987. 13) Kanatsuka, H., Lamping, K. G., Eastham, C. L., Dellsperger, K. C. and Marcus, M. L.: Comp a rison of the effects of increased MVO2 and adenosine on the coronary microvascular resis tance. Circ. Res., (in press). 9) Marcus, M. L.: Autoregulation in the coronary circulation, in Marcus, M. L. (ed): Th e Coronary Circulation in Health and Disease. New York: Mcgraw-Hill Book Company, 93, 1983. 16) Ashikawa, K., Kanatsuka, H., Suzuki, T. and Takishima, T.: A new microscope system for the continuous observation of the coronary microcirculation in the beating canineleft ventricle. Microvasc. Res., 28: 387, 1984. 14) Cox, R. H.: Mechanical properties of the coronary vascular wall and the contractile process, in Kalsmer's (ed): The Coronary Artery. London, Oxford, 59, 1982. 10) Driscol, T. E., Moir, T. W. and Eckstein, W.: Autoregulation of coronary blood flow: Effect of interarterial pressure gradients. Circ. Res., 15: 103, 1965. 3) Kanatsuka, H., Lamping, K. G., Eastham, C. L. and Marcus, M. L.: Heterogenous changes in epimyocardial microvascular size during graded coronary stenosis: Evidence of the micro vascular site for autoregulation. Circ. Res., (in press). 4) Kanatsuka, H., Lamping, K. G., Eastham, and Marcus, M. L.: Nitroglycerin dilates coronary arterial microvessels in ischemic myo c ardium (Abstract). Circulation, 78 (Supp l. 2): 482, 1988. 1) Berne, R. M.: Regulation of coronary blood flow. Physiological Rev., 44: 1, 1964. 12) Kanatsuka, H., Lamping, K. G., Eastham, C. L. and Marcus, M. L.: Non-uniform effect of nitroglycerin on different size coronary arterial microvessels (Abstract). FASEB Jourana l, 2: A 496, 1988. 18) Chilian, W. M., Eastham, C. L., Layne, S. M. and Marcus, ML.: Non-uniform a-adrenergic constriction in the coronary circulation (Abstrac t ). Circulation, 74: (Suppl. 2): 242, 1986. |
| References_xml | – reference: 11) Messina, L. M., Hanley, F. L., Uhlig, P. N., Bear, R. W., Grattan, H. T. and Hoffman, J. I. E.: Effects of pressure gradients between bran c hes of the left coronary artery on the press u re axis intercepts and the shape of steady statec ircumflex pressure-flow relations in the dog. Circ. Res., 58: 11, 1985. – reference: 18) Chilian, W. M., Eastham, C. L., Layne, S. M. and Marcus, ML.: Non-uniform a-adrenergic constriction in the coronary circulation (Abstrac t ). Circulation, 74: (Suppl. 2): 242, 1986. – reference: 17) Ashikawa, K., Kanatsuka, H., Suzuki, T. and Takishima, T.: Phasic blood flow velocity pattern in epimyocardial microvessels in the beating canine left ventricle. Circ. Res., 59 704, 1986. – reference: 15) Feigel, E. O., Buffington, C. W. and Natham, H. J.: Adrenergic coronary vasoconstriction during myocardial underperfusion. Circulation, 75(Suppl. 1): 1, 1987. – reference: 4) Kanatsuka, H., Lamping, K. G., Eastham, and Marcus, M. L.: Nitroglycerin dilates coronary arterial microvessels in ischemic myo c ardium (Abstract). Circulation, 78 (Supp l. 2): 482, 1988. – reference: 10) Driscol, T. E., Moir, T. W. and Eckstein, W.: Autoregulation of coronary blood flow: Effect of interarterial pressure gradients. Circ. Res., 15: 103, 1965. – reference: 13) Kanatsuka, H., Lamping, K. G., Eastham, C. L., Dellsperger, K. C. and Marcus, M. L.: Comp a rison of the effects of increased MVO2 and adenosine on the coronary microvascular resis tance. Circ. Res., (in press). – reference: 19) Lamping, K. G., Kanatsuka, H., Eastham, C. L., Chilian, W. M. and Marcus, M. L. Non-unifo r m vasomotor responses of the coronary microcirculation to serotonin and vasopressin. Circ. Res., (in press). – reference: 12) Kanatsuka, H., Lamping, K. G., Eastham, C. L. and Marcus, M. L.: Non-uniform effect of nitroglycerin on different size coronary arterial microvessels (Abstract). FASEB Jourana l, 2: A 496, 1988. – reference: 2) Dole, W. P.: Autoregulation of the coronary circulation. Prog. Cardiovasc. Dis., 24: 293, 1987. – reference: 3) Kanatsuka, H., Lamping, K. G., Eastham, C. L. and Marcus, M. L.: Heterogenous changes in epimyocardial microvascular size during graded coronary stenosis: Evidence of the micro vascular site for autoregulation. Circ. Res., (in press). – reference: 8) Rouleau, J., Boerboom, L. E., Surjadhara, A. and Hoffman, J. I. E.: The role of autoregulatio n and tissue diastolic pressure in the transmural distribution of left ventricular bloo d flow in anesthetized dogs. Circ. Res., 45: 804, 1979. – reference: 9) Marcus, M. L.: Autoregulation in the coronary circulation, in Marcus, M. L. (ed): Th e Coronary Circulation in Health and Disease. New York: Mcgraw-Hill Book Company, 93, 1983. – reference: 1) Berne, R. M.: Regulation of coronary blood flow. Physiological Rev., 44: 1, 1964. – reference: 16) Ashikawa, K., Kanatsuka, H., Suzuki, T. and Takishima, T.: A new microscope system for the continuous observation of the coronary microcirculation in the beating canineleft ventricle. Microvasc. Res., 28: 387, 1984. – reference: 14) Cox, R. H.: Mechanical properties of the coronary vascular wall and the contractile process, in Kalsmer's (ed): The Coronary Artery. London, Oxford, 59, 1982. – reference: 6) Page, I. H.: The production of persistent arterial hypertension by cellophane perinephr it is. Jour. AMA., 2: 2046, 1939. – reference: 5) Nellis, S. H., Liedtke, A. J. and Whitesell, L.: Small coronary vessel pressure and diameter in an intact beating rabbit heart using fixed-position and free motion techniques. Circ. Res., 49: 1202, 1981. – reference: 7) Chilian, W. M., Eastham, C. L. and Marcus, M. L.: Microvascular distribution of coronary vascular resistance in the beating left ventricle. Am. J. Physiol., 251: H 779, 1986. – reference: 20) Isoyama, S., Sato, F. and Takishima, T.: Normalization of impaired coronary autore g ulation, decreased flow reserve and diminished hyperemic response in hypertrophied rat heat. (submited to Hypertension. ) |
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| Title | 研究会 第23回 河口湖心臓討論会 虚血性心筋障害 心筋虚血における冠血管抵抗の調節部位 |
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