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心筋機能障害の成立における力学的負荷と循環自動調節能の意義について

机械负荷和循环自动调节在心肌功能障碍发生中的意义

基本信息

批准号：
63624511
负责人：
友池仁暢
金额：
$ 1.15万
依托单位：
Kyushu University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research on Priority Areas
财政年份：
1988
资助国家：
日本
起止时间：
1988 至无数据
项目状态：
已结题

项目摘要

目的:心筋機能の障害は心室における力学的負荷と冠循環の循環特性によって規定される。左冠動脈の灌流圧-血流量関係と心筋機能の関連性は良く知られているが、右冠動脈については詳細な検討は乏しい。本研究では右冠動脈における灌流圧と、右総冠血流量、放射性標識微粒子による心室壁の層毎の血流分布量、局所心筋機能との関係を麻酔開胸犬を用いて検討した。右冠動脈における自動調節能の有無、心筋機能と循環調節機構との相互関連性を明らかにせんとした。方法:成犬を麻酔下に開胸し、右冠動脈と頚動脈の間に自己動脈血灌流路を作製した。灌流路に狭窄を作り灌流圧を低下させ、血流量変化をカニューレ型電磁流量プローブで、局所血流量を放射性標識微粒子法で、局所心筋短縮能を超音波法で測定した。狭窄解放時の血流量増加を反応性充血と定義し、debt repaymentを測定した。結果:右冠動脈では灌流圧の低下に比例して流入血流量も直線的に減少した。灌流圧と右室自由壁全層、内膜側或いは外膜側血流量との間にも直線関係を認めた。灌流圧が低下しても内外血流分布比は約1であった。局所心筋短縮率は冠動脈圧が39mmHg迄は一定に保たれ、更に低い血圧では血圧に比例して短縮率も小さくなった。局所心筋短縮率が変化しない程度の灌流圧(60mmHg)で反応性充血の出現を認め、灌流圧の低下と共に増大した。(p<0.01)。考察:右冠動脈における灌流圧-血流量関係の直線性は自動調節能が弱いことを示唆している。左冠動脈系の知見と異る理由は心室自由壁の厚さが薄い事、右室門圧が低い事(左室の1/4)によると思われる。局所心筋短縮率は灌流圧が40%近くまで低下しても保たれており、心機能から見た右冠動脈は予備能の大きな循環系であると考えられた。今後、後負荷の影響、心ポンプ予備力を定量的に解明する予定である。

Purpose: To determine the mechanical load of the ventricle and the circulatory characteristics of the coronary circulation through the impairment of cardiac muscle function. The perfusion pressure-blood flow relationship of the left coronary artery and the correlation of cardiac muscle function are both good and good, and the right coronary artery is detailed. This study examined the relationship between perfusion pressure of the right coronary artery, right coronary blood flow, blood flow distribution volume of radioactive labeled microparticles in each layer of the ventricular wall, and local myocardial function. The presence or absence of the right coronary artery's auto-regulatory function, the interrelationship between the cardiac muscle function and the circulatory regulating mechanism are known. Methods: In adult dogs, thoracotomy was performed under anesthesia, and a self-arterial blood perfusion path was created between the right coronary artery and the right artery. The perfusion path was narrowed and the perfusion pressure was low, the blood flow was changed and the electromagnetic flow rate was measured, the local blood flow was measured by the radioactively labeled microparticle method, and the local myocardial shortening energy was measured by the ultrasonic method. The increase in blood flow during stenosis release is defined as reaction hyperemia, and debt repayment is measured. Results: The proportion of right coronary artery perfusion pressure decreased and the inflow blood flow decreased linearly. There is a straight-line relationship between perfusion pressure and right ventricular free wall thickness, intimal side or adventitial side blood flow. The low perfusion pressure means that the internal and external blood flow distribution ratio is about 1. The local myocardial shortening rate is still stable when the coronary artery pressure reaches 39mmHg, and the blood pressure is lower than the blood pressure ratio, and the shortening rate is small. The local myocardial shortening rate has not changed, and the degree of perfusion pressure (60mmHg) and the occurrence of reaction hyperemia can be recognized. (p<0.01). Investigation: The relationship between perfusion pressure and blood flow of the right coronary artery is linear and the automatic adjustment ability is weak and weak. The reason for the differences in the left coronary artery system is that the free wall of the ventricle is thick and thin, and the portal pressure of the right ventricle is low (1/4 of the left ventricle). The local myocardial shortening rate is close to 40% of the perfusion pressure, and the rate is low. The function of the heart can be seen and the right coronary artery can be pre-prepared and the circulatory system can be tested. From now on, the influence of afterload and the preparatory strength of the heart will be quantitatively explained and determined.