用放射性核素阻塞体积描记法对人体体循环静脉顺应性进行定量评估——方法及硝酸甘油的作用

Quantitative estimation of compliance of human systemic veins by occlusion plethysmography with radionuclide--methodology and the effect of nitroglycerin.

作者信息

Takatsu H, Gotoh K, Suzuki T, Ohsumi Y, Yagi Y, Tsukamoto T, Terashima Y, Nagashima K, Hirakawa S

机构信息

Second Department of Internal Medicine, Gifu University School of Medicine, Japan.

出版信息

Jpn Circ J. 1989 Mar;53(3):245-54. doi: 10.1253/jcj.53.245.

DOI:10.1253/jcj.53.245

PMID:2545936

Abstract

Volume-pressure relationship and compliance of human systemic veins were estimated quantitatively and noninvasively using radionuclide. The effect of nitroglycerin (NTG) on these parameters was examined. Plethysmography with radionuclide (RN) was performed using the occlusion method on the forearm in 56 patients with various cardiac diseases after RN angiocardiography with 99mTc-RBC. The RN counts-venous pressure curve was constructed from (1) the changes in radioactivity from region of interest on the forearm that were considered to reflect the changes in the blood volume of the forearm, and (2) the changes in the pressure of the forearm vein (fv) due to venous occlusion. The specific compliance of the forearm veins (Csp.fv; (1/V).(delta V/delta P] was obtained graphically from this curve at each patient's venous pressure (Pv). Csp.fv was 0.044 +/- 0.012 mmHg-1 in class I (mean +/- SD; n = 13), 0.033 +/- 0.007 mmHg-1 in class II (n = 30), and 0.019 +/- 0.007 mmHg-1 in class III (n = 13), of the previous NYHA classification of work tolerance. There were significant differences in Csp.fv among the three classes. The systemic venous blood volume (Vsv) was determined by subtracting the central blood volume, measured by RN-angiocardiography, from total blood volume, measured by the indicator dilution method utilizing 131I-human serum albumin. Systemic venous compliance (Csv) was calculated from Csv = Csp.fv.Vsv. The Csv was 127.2 +/- 24.8 ml.mmHg-1 (mean +/- SD) in class I, 101.1 +/- 24.1 ml.mmHg-1 in class II and 62.2 +/- 28.1 ml.mmHg-1 in class III. There were significant differences in Csv among the three classes. The class I Csv value was calculated to be 127.2 +/- 24.8 ml.mmHg-1 and the Csv/body weight was calculated to be 2.3 +/- 0.7 ml.mmHg-1.kg-1 of body weight, which was very close to the values for Csv reported previously by other investigators in animal experiments. The administration of NTG caused the RN counts - venous pressure curve to become steeper and shift upward. It increased Csv significantly in all cases.

摘要

使用放射性核素对人体体循环静脉的容积 - 压力关系及顺应性进行了定量和无创评估。研究了硝酸甘油（NTG）对这些参数的影响。在56例患有各种心脏病的患者中，于99mTc - RBC进行放射性核素心血管造影后，采用阻塞法在前臂进行放射性核素体积描记术（RN）。通过以下方式构建RN计数 - 静脉压力曲线：（1）前臂感兴趣区域放射性的变化，其被认为反映了前臂血容量的变化；（2）静脉阻塞导致的前臂静脉（fv）压力变化。根据每位患者的静脉压力（Pv），从该曲线以图形方式获得前臂静脉的比顺应性（Csp.fv；(1/V)·(δV/δP)）。在前纽约心脏协会（NYHA）工作耐受分级中，I级患者（均值±标准差；n = 13）的Csp.fv为0.044±0.012 mmHg⁻¹，II级患者（n = 30）为0.033±0.007 mmHg⁻¹，III级患者（n = 13）为0.019±0.007 mmHg⁻¹。这三个级别之间的Csp.fv存在显著差异。通过从利用¹³¹I - 人血清白蛋白的指示剂稀释法测量的总血容量中减去放射性核素心血管造影测量的中心血容量来确定体循环静脉血容量（Vsv）。体循环静脉顺应性（Csv）通过Csv = Csp.fv·Vsv计算得出。I级患者的Csv为127.2±24.8 ml·mmHg⁻¹，II级患者为101.1±24.1 ml·mmHg⁻¹，III级患者为62.2±28.1 ml·mmHg⁻¹。这三个级别之间的Csv存在显著差异。I级患者的Csv值经计算为127.2±24.8 ml·mmHg⁻¹，Csv/体重经计算为2.3±0.7 ml·mmHg⁻¹·kg⁻¹体重，这与其他研究者先前在动物实验中报告的Csv值非常接近。给予NTG导致RN计数 - 静脉压力曲线变得更陡峭并向上移动。在所有情况下，它均显著增加了Csv。