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はじめに
1974年,Demaridら1)は,心エコー図法を用いて,Nitoroglycerin(NTG)舌下投与の左室機能に及ぼす影響を検討し,同剤の投与後,左室の拡張末期径(Dd)および収縮末期径(Ds)が減少することを報告した。本邦でも,若松ら2)が同様の結果を報告しているが,著者ら3)も同様の方法で追試し確認した。この左室径の減少の機序には前負荷,後負荷,心拍数の変化や,心筋収縮力の変化が関与すると考えられているが,その主因については必らずしも明確でない。
今回NTGの舌下時の左室径の減少に,同剤投与後に生ずる反射性頻脈の及ぼす影響を検討する目的で,心拍数が固定されているpacemaker植込み群(pacemaker群)と,心拍数が変化し得るcontrol群とで,NTGを舌下投与し,左室内径の変化,血行動態の変化について比較検討したので報告する。
The effects of nitroglycerin (NTG) on cardiacfunction can be evaluated by echocardiography. In this paper, we discussed the effects of NTG on cardiac function in two groups, one who had pacemaker implanted and their heart rate was fixed, and in other control group. Using echocardiography, left ventricular dimension was obtained in standard manner (Toshiba-SSH-11 A). Left ventricular end-diastolic dimension (Del) and end-systolic dimension (Ds) were obtained in each case and ejection fraction was calculated. After NTG (0.6 mg) sublingually, blood pressure decreased in two groups. Heart rate was fixed in the pacemaker group but increased significantly in control group. Dd and Ds were found to decrease only in the control group. Ejection fraction showed an increase in the majority of control group but it remained stationary. Heart rate change therefore may play a role in dimensional change and pumping function of heart after NTG.
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