A Study on Intraoperative Management of Venous Return Mechanism

静脉回流机制的术中管理研究

• 批准号: 04454398
• 负责人: MUTEKI Takesuke
• 金额: $ 3.97万
• 依托单位: Kurume University School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1992
• 资助国家: 日本
• 起止时间: 1992 至 1993
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-04454398/
• 关键词: venour return (VR); cardiac wall thickness; stunned myocardium; Emax; resistance of VR; preload reserve; HFJV; coronary occlusion; stunned nyocardium; 静脈還流動態; 心室拡張能; 心室壁厚変位; 心筋虚血; 冠動脈心室内圧較差; PEEP; Valsalva

Cardiodynamic analysis of venous return (VR) mechanism has been investigated in order to develop a strategy of circulatory management of hemodynamic instabities during surgery. Cardiodynamic analysis of VR mechanism was conducted in dogs by measurement of a fine CVP waveforms (especially "Y" wave) and enlarged EKG due to DC-coupling with use of a fibroptic technique. "Y" wave of CVP was used as a reference pressure for calculation of a theoretical value of mean systemic pressure (Pms) with use of a graphic analysis due to Valsalva maneuver (Muteki's method) and vascular resistance of VR (ROVR) was obtained. The other cardiodynamic parameters related venous return were involved by LVP negative and positive max dp/dt, Emax, myocardial wall thickness (WT), which were closely related to changes of QRS amplitude and ST segment of EKG.These carrdiodynamic parameters were in stunned myocardium during cardiac resuscitation comparatively investigated between a global ischemia (A) group in reperfusion from cardiac massage for cardiac arrest due to VF, and a regional ischemia (B) group of LAD occlusion. The following reults were obtained ; (1)Cardiodynamic analysis of VR facilitated to conduct a new development for strategy of circulatory management. (2)Cardiodynamic parameters of VR mechanism were recognized to be significantly more salient in detecting an early sign of hemodymic instability in myocardial ischemia in A group than in B group. (3)Electromechanical association between QRS amplitude of endo -, and epicardial EKG and myocardial WT was found in stunned myocardium due to LAD occlusion experiment in swine. (4)Postsystolic WT was more eminent significantly during recovery period of stunned myocardium from in B group than in A group with delayd recovery of Emamx. (5)Comparative study on cardiodynamic analysis of VR mechanism between in HFJV and IPPV, ROVR was higher maintained in hemorrhage experiment, but not significantly changed in fluid replacement in HFJV, and it

为了制定手术期间血流动力学不稳定的循环管理策略，研究了静脉回流（VR）机制的心动力分析。通过测量狗的精细CVP波形（特别是“Y”波）和增大的心电图（由于直流耦合使用纤维化技术），对VR机制进行了心脏动力学分析。以CVP的“Y”波作为参考压力，通过Valsalva机动（Muteki方法）的图形分析计算平均系统压力（Pms）的理论值，并获得VR的血管阻力（ROVR）。与静脉回流相关的其他心动力参数包括LVP阴性和阳性max dp/dt、Emax、心肌壁厚（WT），与心电图QRS幅值和ST段变化密切相关。在心脏复苏期间休克心肌的这些心动力学参数对比研究了心室颤动引起心脏骤停的心脏按摩再灌注时的全局缺血(a)组和LAD闭塞时的局部缺血(B)组。得到以下结果：(1) VR的心动力学分析有助于循环管理策略的新发展。(2)与B组相比，A组VR机制的心动力参数在检测心肌缺血血流动力学不稳定早期体征方面更为显著。(3)在猪LAD闭塞休克心肌实验中，心外膜心电图、心外膜心电图的QRS幅值与心肌WT存在机电相关。(4) Emamx延迟恢复的B组在休克心肌恢复期收缩后WT显著高于A组。(5) HFJV与IPPV之间VR机制的心动力分析对比研究，出血实验中ROVR维持较高，补液实验中ROVR无明显变化

项目成果

無敵 剛介: "静脈還流動態よりみた心肺蘇生法の検討" 蘇生. 11. 31-43 (1993)

Kosuke Muteki：“从静脉回流动力学角度研究心肺复苏”复苏。 11. 31-43 (1993)

Sumio Hoka: "Intra-operative blood pressure control by prostaglandin E_1 in a patinets with hypertension and ischemic heart disease" Journal of Anesthesia. 7. 173-183 (1993)

Sumio Hoka：“前列腺素 E_1 在患有高血压和缺血性心脏病的患者中控制术中血压”《麻醉杂志》。

Takesuke Muteki: "A Study on Biometric Monitoring" Journal of Japanese Association of Operating Room Technology. 14. 3-8 (1993)

Takesuke Muteki：“生物识别监测研究”日本手术室技术协会杂志。

無敵 剛介: "術中生体情報計測に関する研究 ーCPU搭載光伝送心電計の試作による術中ノイズ対策" 第12回医療情報学連合大会論文集. 201-202 (1992)

Kosuke Muteki：“术中生物信息测量研究 - 通过原型设计配备 CPU 的光传输心电图仪来对抗术中噪声”第 12 届医学信息学联盟会议记录 201-202（1992 年）。

戸畑 裕志: "電気メス放電時に発生する低周波電圧・電流成分に関する基礎的研究" 医科器械学. 62. 380-388 (1992)

Hiroshi Tobata：“电手术刀放电时产生的低频电压和电流分量的基础研究”《医疗器械科学》62. 380-388 (1992)。