Japanese
TitleNon-invasive circulatory monitoringの問題点
Subtitle第1回循環制御研究会記録 総説講演
Authors劔物修
Authors(kana)
Organization北里大学医学部麻酔科
Journal循環制御
Volume1
Number1
Page8-21
Year/Month1980/
Article報告
Publisher日本循環制御研究会
Abstract緒言 非観血的に頸動脈波, 心電図, 心音図を同時に記録することで得られる心収縮時相systolic time intervals：STIは心臓病学の分野でnon-invasiveな, 心機能を知る一手段として確立されたものである1〜4）. 本法の有用性については多くの報告があり, (1)STIの測定が正確な情報を提供するのか？, (2)左室機能を知る他の方法との相関性？, について種々の検討が行われてきている. 本法の最大の利点は非侵襲的であるために, 頻回の測定が可能であり, 心疾患の経過や治療に対する反応を長時間にわたり観察できることにある1）. 心臓病学の領域では, 心筋梗塞や冠動脈疾患時の左室機能の変化はもとより, 種々の薬物療法に対する効果を知るうえに応用されてきている5〜9）. 麻酔科領域におけるSTI測定の応用も種々試みられている10〜21）. 前駆出時期pre-ejection period：PEP, 左室駆出時間left ventricular ejection time：LVETに及ぼす麻酔薬や麻酔方法の影響が検討され, 有意の変化として把握できないとする報告や量依存性の変化を認めるとする成績がある.
Practice基礎医学・関連科学
Keywordsnon-invasive, circulatory monitoring, operating room, systolic time intervals, PEP/LVET, anesthetics, sympathomimetic agents
English
TitleCurrent concepts in non-invasive circulatory monitoring, especially in the operating room
Subtitle
AuthorsOsamu Kenmmotsu
Authors(kana)
OrganizationDepartment of Anesthesiology, Kitasato Univeosity School of Medicine
JournalCirculation Control
Volume1
Number1
Page8-21
Year/Month1980/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractAmong several non-invasive methods for assessing cardiac performance such as peumocardiogram, impedance cardiogram, ultrasound cardiogram, Doppler velocity meter and systolic time intervals（STI）, STI is quite promissing in perioperative cardiovascular monitoring. Some experience with intraoperative, computerized STI monitoring system allows us to answer the following questions related to the use of STI monitoring in the operating room. These questions are 1） whether STI measurement is desirable and feasible in the operating room, 2） whether STI is useful to the anesthesiologist, and 3） whether STI is acceptable as non-invasive, intraoperative circulatory monitoring. The following statements, may justify to answer to the above questions； 1） STI can be detected non-invasively, minimizing iatrogenic complications. 2） The preparation time for STI measurement is minimal. 3） Electrical safety is comfirmed. 4） The components of the STI； PEP （preejection period）, LVET（left ventricular ejection time）and the ratio of PEP/LVET display some characteristic changes of depression and improvement of cardiac function by both anesthetics and sympathomimetic agents used during anesthesia. 5） STI, especially PEP/LVET appear to be sensitive to changes in preload, afterload and contractile state of myocardium 6） Automated STI measurement provides the continuous and beat-to beat information to the anesthesiologist. 7） The simultaneous use of STI and pressure time indices（PTI） as DPTI/TTI ratio provides indications of the balance of cardiac oxygen consumption with supply, and may be more informative in regard to the cardiac conditions fo the patients in perioperative period. 8） When associated with monitoring of heart rate, blood pressure and PTI, STI extremely improve the analysis of the cardiovascular reaction to pharmacologic and pathophysiologic events, and may be useful for the titration of anesthetic drugs and for the detection of early changes in the cardiovascular system of the patient. However, it is also true that some problems exist concering on the compatibility with surgical procedures. For instance, face and neck surgery as well as procedures in the lateral and prone positions can interfere with the carotid pulse transducer, and so do procedures in the chest with the heart sound transducer. Then STI monitoring techniques using esophageal transducers should be evaluated. I believe that current technology in medicine may make those techniques applicable in the near future.
PracticeBasic medicine
Keywordsnon-invasive, circulatory monitoring, operating room, systolic time intervals, PEP/LVET, anesthetics, sympathomimetic agents

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