Circulatory Management of Venous Return Mechanism during Anesthesia

麻醉期间静脉回流机制的循环管理

• 批准号: 60480352
• 负责人: MUTEKI Takesuke
• 金额: $ 3.78万
• 依托单位: Kurume University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1985
• 资助国家: 日本
• 起止时间: 1985 至 1986
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-60480352/
• 关键词: mean systemic pressure; CVP waveform; electromechanical analysis; right atrial function venous return mechanism; 静脈還流抵抗; 肺血管抵抗; preload; 循環平均圧

In order to extend clinical significance of monitoring central venous pressure(CVP),elecrromechanical analysis of CVP waveform has been attempted on surgical patients under anesthesia CVP waveform and other hemo-dynamic parameters were measured and recorded by our fiberoptic pressure monitoring system with Millar's micromanometry. This system was specially designed to achieve not only electric safety but also high fidelity and noise performance and the pressure amplifier was also specially designed with stabilizing circuit to depress base line awaring in order to obtain accurately enlarged CVP waveforms even under surgery with electrocautery. Electromechanical indicies of the a, c and v waves of CVP were obtained for assessment of RV function with a special reference of venous return mechanism.With an identification of Y wave from the CVP wave forms, dynamic mean systemic pressure (d.Pms) has been clinically measured by graphic analysis on the theoretical basis (Hori,M., 1969) by our technique of Valsalva's maneuver during surgery in a state where the heart is functioning. The d.Pms , which was obtained under Halothane anesthesia with 108.5 <+!-> 5.97 mmHg in systolic blood pressure was 7.00 <+!-> 0.65(mean <+!-> SE, n=11),and the resistance of VR(GVR) was calculated by the equation of d.Pms-CVP (y)/VR and 250.8 <+!-> 20.9 dyne sec <cm^(-5)> was obtained. GVR was usually well maintained under a stable condition of circulatory equilibrium (Guyton) under anesthesia.With these experimental results, a new concept for CVP measurement and physiological significance of the resistance of VR was recognized.

为了扩大中心静脉压（CVP）监测的临床意义，本文对麻醉状态下手术病人的CVP波形进行了机电分析。该系统经过特殊设计，不仅具有电气安全性，而且具有高保真度和噪声性能，压力放大器还专门设计了稳定电路，以抑制基线awaring，从而即使在电烙术下也能获得精确放大的CVP波形。获得了CVP的a、c和v波的机电指标，用于评估RV功能，并特别参考了静脉回流机制。通过从CVP波形中识别Y波，在理论基础上通过图形分析临床测量了动态平均体循环压（d.Pms）（Hori，M.，1969年）通过我们的技术Valsalva的机动手术期间的状态下，心脏功能。在氟烷麻醉下，用108.5 μ g/ml的地塞米松（108.5 μ g/ml）和108.5 μ g/ml的地塞米松（108.5 μ g/ml）分别测定d.Pms。5.97收缩压为7.00 mmHg <+！-> 0.65（平均值<+！-> SE，n=11），用d.Pms-CVP（y）/VR和250.8 ± 1.0计算VR阻力（GVR）。20.9获得达因秒<cm^（-5）>。GVR通常在麻醉状态下维持在稳定的循环平衡状态（盖顿），本实验结果为CVP的测定和VR阻力的生理意义提供了新的概念。

项目成果

Muteki, T.: Ecerpta Medica Asia Ltd.RACS Foundation Symposium on Fluid (No.43) Current concepts on intra-operative use of the plasma substitute (Haemaccel ) with maintenance of preload reserve of right side cardiac function under anaesthesia, p.77-p.90 (1

Muteki, T.：Ecerpta Medica Asia Ltd.RACS 基金会流体研讨会（第 43 期）术中使用血浆替代品 (Haemaccel ) 并在麻醉下维持右侧心脏功能前负荷储备的当前概念，第 77 页

Muteki,T.: "RACS Foundation Symposium on Fluid(No.43)(Title)Current concepts on intra-operative use of the plasma substitute(Haemaccel)with maintenance of preload reserve of right side cardiac function under anaesthesia" Ecerpta Medica Asia Ltd., .77- .90

Muteki,T.：“RACS 基金会流体研讨会（第 43 期）（标题）术中使用血浆替代品 (Haemaccel) 并在麻醉下维持右侧心脏功能前负荷储备的当前概念” Ecerpta Medica Asia Ltd

Muteki, T., Aragaki, T., Gotoh, S., Shimizu, D., Sueyoshi, F., Kohno, I., Tokutomi, Y., and Takagi, T.: "Maiatenance of Preload Reserve of Right Sided Cardiac Function by Administration of TNG during Rapid Administration of Plasma Expander (Haemaccel ) un

Muteki, T.、Aragaki, T.、Gotoh, S.、Shimizu, D.、Sueyoshi, F.、Kohno, I.、Tokutomi, Y. 和 Takagi, T.：“右侧心脏预负荷储备的 Maiatenance

Watanabe, S., Iwakuma, I., Ohishi, K., Gotoh, S., Tsuda, H. and Muteki, T.: "Electrocardiographic and Hemodynamic Changes in Coronary Angiospasm" The Journal of Japan Society for Clinical Anesthesia. 6. 486-492 (1986)

Watanabe, S.、Iwakuma, I.、Ohishi, K.、Gotoh, S.、Tsuda, H. 和 Muteki, T.：“冠状动脉血管痉挛的心电图和血流动力学变化”日本临床麻醉学会杂志。

新垣敏幸,無敵剛介,河野一造,戸畑裕志,高木俊明: 日本手術部医学会誌. 6. 242-246 (1985)

Toshiyuki Aragaki、Kosuke Muteki、Kazuzo Kono、Hiroshi Tobata、Toshiaki Takagi：日本外科学会杂志 6. 242-246 (1985)。