| Japanese |
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| Title | 自律神経系と洞不全症候群 |
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| Subtitle | 特集 |
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| Authors | 池田孝之*, 松下重人*, 阪上学*, 勝木達夫*, 久保田幸次*, 高田重男* |
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| Organization | *金沢大学第1内科 |
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| Journal | 循環制御 |
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| Volume | 10 |
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| Number | 2 |
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| Page | 167-173 |
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| Year/Month | 1989/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「はじめに」洞結節機能は洞結節固有の刺激生成能と洞房伝導能及びこれらに影響する外的要因により決定される. 外的要因の中で最も重要なものは自律神経の関与である1),2). そしてこの自律神経の関与のありかたとして, 1)洞結節は正常であるが, 自律神経系の変化により機能的徐脈を示す場合, 2)洞結節の障害があるが, 自律神経系は正常者と同様に作用しているとき, 3)洞結節の障害があり, かつ自律神経系の作用が正常と異なる時, である3),4). 本研究は洞失調症候群患者(SSS患者)における自律神経系の関与を明らかにするために自律神経遮断薬を用いた洞周期の変動について検討したものである. 「対象」めまい, 失神, 胸痛, 動悸などの症状を有し心電図上1分間50以下の洞性徐脈, 洞房ブロック, 洞停止が認められた, 患者56名を対象とした, 内訳は男34名, 女22名, 年令は58±16才である. SSSの診断はFerrer, Ruheusteinらの基準を満たすものとした. 「方法」薬物的自律神経遮断(PAB)はPAB前の基本周期(BCL)を求めた後, プロプラノロール0.2mg/kgを10分で静脈内投与し, 投与10分後にP-P間隔を測定した後アトロピン0.04mg/kgを3分間で注入し, 終了5分後のP-P間隔をintrinsic cycle legth(ICL)とした. P-P間隔はプロプラノロール及びアトロピン投与前, 各薬剤投与後のいずれも20心拍の平均をとりmsecで表示した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | sick sinus syndrome, autonomic nerve system, propranolol, atropine, pacemaker |
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| English |
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| Title | Autonomic Nerve Influences on Sick Sinus Syndrome |
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| Authors | Takayuki Ikeda, Shigeo Matsushita, Manabu Sakagami, Tatsuo Katsuki, Kouji Kubota, Shigeo Takata |
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| Organization | Department of Internal Medicine School of Medicine Kanazawa University |
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| Journal | Circulation Control |
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| Volume | 10 |
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| Number | 2 |
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| Page | 167-173 |
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| Year/Month | 1989/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Sinus node responsiviness to autonomic activity was studied in 56 patients with the sick sinus syndrome and normal controls, using autonomic blockade (AB) with propranolol 0.2 mg/kg (P) followed by atropine 0.04 mg/kg (A), I.V.. Autonomic stimulations with isoproterenol infusion, baroreflex tests and the performance of the Valsalva maneuver were examined. Electrophysiological parameters including sinus cycle length (ICL) after AB and sinus node recovery time (SNRT) were assessed. Twenty eight patients out of 56 responded normally to A, P and autonomic stimulations. These patients were thought to have redued automaticity of sinus node with normal autonomic regulation (group A). The other 28 patients did not normally respond to A and autonomic stimulations (group B). Group B patients were further divided into two troups, one was 12 patients in whom lengthening of P-P interval by P was more than 20% (group BI), the other was 16 patients with lengthening of P-P intervals by P less than 20% (group BII). Sinus node function could be abnormal in the group B patients with sympathetic compensation in the BI and automic denervation in the BII. Clinical symptoms were severer, and ICL and SNRT were significantly longer in group B than in group A. As for clinical features during the folow up study, 22 of group A patients were uneventful without pacemaker implantaion. On the contrary, in 21 of group B pacemaker implantation was needed, resulting in symptomatic improvement in 13 patients. There results indicate that heterogenous paticipations of autonomic nerve system may exist in the sick sinus syndrome, and that therefore, the classification by autonomic blockade is valuable in clinical assessment of the sick sinus syndrome. |
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| Practice | Basic medicine |
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| Keywords | sick sinus syndrome, autonomic nerve system, propranolol, atropine, pacemaker |
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