まとめ
パルサスパラドクスは,呼吸中の心臓の充填の変化を伴う. これらの発見は,心臓タンポネードと閉塞性呼吸道疾患において,右心室と左心室の充填のインスピレーションによる変化が起こることを示唆しています.
科学分野:
- 心臓病学 心臓病学
- 生理学 生理学とは
背景:
- パルサスパラドックス (Pulsus paradoxus) は,インスピレーション中に静脈血圧とパルス波の振幅の異常な低下によって特徴づけられる臨床的徴候です.
- 心臓タンポネードと慢性阻害性呼吸道疾患 (COPD) は,パルサスパラドックスで表れます.
研究 の 目的:
- 心臓タンポネードとCOPDの患者におけるパルスパラドックスに関連した血液動力学的変化を調査する.
- 心臓タンポネードと,パルサスパラドクスを引き起こす他の状態を区別する.
主な方法:
- 呼吸サイクル中の心室の寸法とミトラ弁の流入パターンのエコーカルディオグラフィの評価.
- 心臓のタンポネード (心筋縮前と後) とCOPDの患者と,大きな心筋流が有るがタンポネードがない対照群の患者での発見の比較.
主要な成果:
- 心臓タンポネードを受けた患者は,インスピレーションによって右心室のダイアストリック直径が増加し,左心室のダイアストリック直径が減少した.
- ミトラル弁のE-ポイントからA-ポイント (DE) の振幅とE-Fの傾きは,心臓タンポネードを持つほとんどの患者のインスピレーション中に減少しました.
- COPDとパルサスパラドクサスを持つ2人の患者でも同様のインスピレーションによる血液動力学的変化が観察されましたが,タンポネードなしで大きな心周出血を流した患者ではそうではありませんでした.
結論:
- 右心室の充填のインスピレーションによる増加と左心室の充填の減少は,パルサスパラドクスの重要なメカニズムです.
- これらの発見は,心臓タンポネードに存在し,また,パルスパラドックスに関連した閉塞性呼吸道疾患でも発生することがあります.
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