文献一覧: 三船順一郎 (著者)

1 0 0 0 OA 脳卒中と心電図変化その成因に関する臨床病理学的検討

著者: 蔵本築桑子賢司松下哲三船順一郎坂井誠岩崎勤賀来俊峰雅宣村上元孝
出版者: 一般社団法人日本老年医学会
雑誌: 日本老年医学会雑誌 (ISSN:03009173)
巻号頁・発行日: vol.15, no.3, pp.267-273, 1978-05-30 (Released:2009-11-24)
参考文献数: 16
被引用文献数: 5

脳出血, 脳梗塞に伴う心電図変化の成因を検討する目的で, 発作前1カ月内及び発作後の心電図, 臨床検査成績が得られ, 剖検上確認された老年者脳出血18例, 脳梗塞29例について, 発作前後の心電図, 臨床検査成績, 血圧の変化, 剖検による冠狭窄度, 脳病変の部位, 大きさ等を対比検討した.発作前後の心電図変化は脳出血88.9%, 脳梗塞89.7%に認められST, T変化がそれぞれ61.1%, 69.0%と高頻度に見られ, 高度な虚血性変化は脳梗塞で多く見られた. 不整脈は脳出血55.6%, 脳梗塞41.4%に見られ, 発作時の心房細動出現は脳梗塞にのみ10.3%に見られた. 期外収縮は脳出血に多く上室性22.1%, 心室性11.1%, 脳梗塞ではそれぞれ10.3%, 3.4%であった.脳卒中発作前後のヘマトクリット上昇は脳梗塞で大きい傾向があり, 虚血性ST, T変化を示した群では脳出血2.44±0.57, 脳梗塞6.04±1.74の上昇を示し, 著明なヘマトクリットの上昇による冠微小循環の障害が虚血性ST, T変化を斉すことを示唆した.脳卒中発作時の収縮期血圧上昇は脳出血では52.5±8.9mmHgで心電図変化の程度に拘らず200mmHg以上の高値を示したが脳梗塞では8.7±10.4とその変動は僅かで血圧上昇が心電図変化の原因とはいえなかった.冠動脈狭窄の程度は脳出血, 脳梗塞共各心電図変化群の間に狭窄指数の差が見られず, 虚血性心電図変化が太い冠動脈の狭窄によるものではないことを示した. 一方心筋梗塞の合併は脳出血5.6%に比し脳梗塞で50.0%と有意に高頻度であった.脳病変の部位, 大きさでは外側型脳出血に虚血性ST, T変化の多い傾向が見られたが, 脳梗塞では中大脳動脈領域の梗塞に於ても心電図変化に一定の傾向はなく, 部位による特徴は認められなかった. また両群共病巣の大きさと心電図変化には一定の傾向は見られなかった.脳出血, 脳梗塞の虚血性心電図変化は病巣の部位, 大きさ, 冠硬化, 血圧上昇等とは関連が認められず, ヘマトクリット上昇による冠微小循環の障害がその一因と考えられた.

2023-03-03 06:59:44
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1 0 0 0 血液ガス

著者: 大塚洋久国枝武義吉岡公夫三重野龍彦青木茂行倉富雄四郎飯島福生荒井達夫吉良枝郎宮本顕二吉川隆志五十嵐英夫山本宏司西浦洋一岸不尽弥川上義和金森一紀東博司高倉文嗣三船順一郎田中孝国枝武義星野重幸内藤雅裕大久保俊平福永保夫吉岡公夫保坂公徳来生哲荒川正昭内藤雅裕福永保夫大久保俊平
出版者: 社団法人日本呼吸器学会
雑誌: 日本胸部疾患学会雑誌 (ISSN:03011542)
巻号頁・発行日: vol.22, pp.98-100, 1984

2021-08-21 17:37:39
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1 0 0 0 血管内凝固症候群とショック

著者: 松田保小河原緑平林直子関俊子横内正利村上元孝島田馨三船順一郎
出版者: 一般社団法人日本血栓止血学会
雑誌: 血液と脈管 (ISSN:03869717)
巻号頁・発行日: vol.9, no.2, pp.208-212, 1978

Recently, growing interests had been devoted largely to disseminated intravascular coagulation (DIC), because of its frequency and clinical importance. It has been known that shock is a frequent complication of DIC, although it has not been elucidated whether shock is a cause of DIC rather than a result. This study was made to clarify relationship between DIC and shock in 699 consecutive autopsied cases, almost all of whom was over age sixty, in Tokyo Metropolitan Geriatric Hospital. The diagnosis of DIC was established when coagulation analysis revealed presence of consumption coagulopathy. Among these cases, 106 had evidences of DIC and 30 had clinical and pathological findings highly suggestive of DIC although the coagulation findings were not specific. Shock was complicated in 38 of the former and 10 of the latter. Eight of these 48 patients with DIC complicated with shock revealed consumption coagulopathy simultaneously with the development of shock. 24 cases had not clea r-cut evidences of DIC immediately after the development of shock in coagulation findings, although they showed marked coagulation abnormalities indicating DIC after the shock developed. 44% of conditions associated with the shock in these patients was gram-negative septicaemia. The other underlying pathologic conditons in these cases consisted of cancer, peptic ulcer, acute myocardial infarction and pneumonia. Onset of shock was observed in 16 cases in whom diagnosis of DIC had been already established by coagulation analysis. 11 cases of these had cancer with metastases, primary organs of which were stomach, colon or biliary tracts. 70% of these patients were febrile. Acute renal failure, purpura, petechiae, melena, coma, epileptic seizure, systemic peripheral gangrene and/or red cell fragmentation in peripheral blood smear were main symptoms in DIC with shock. Four cases, excluding two cases in whom DIC developed following development of acute myocardial infarction, showed ECG findings indicating development of acute myocardial infartion, although myocardial infarction was evident in only one cases by postmortem examination. Presence of fibrin thrombi was confirmed in 36 cases out of the 48 autopsied cases with DIC accompained with shock. Terminal hemorrhagic necrotizing enteropathy was observed in 15 of those cases. Hemorrhage from adrenal was observed in 4 cases. From these results, it is concluded that shock does frequently cause DIC and that shock in gram-negative septicaemia is especially important because of its high incidence to result DIC.

2020-08-31 16:51:16
1 + 1 Wikipedia

1 0 0 0 OA 老年者肺炎における心筋梗塞様心電図

著者: 蔵本築松下哲三船順一郎坂井誠村上元孝
出版者: 一般社団法人日本老年医学会
雑誌: 日本老年医学会雑誌 (ISSN:03009173)
巻号頁・発行日: vol.14, no.2, pp.115-120, 1977-03-30 (Released:2009-11-24)
参考文献数: 12
被引用文献数: 1

老年者肺炎12例に於て肺炎と同時または稍遅れて前壁中隔硬塞を思わせる心電図変化を認めた. すなわちV1-V3, V4のQSまたはrの減高, ST上昇, 冠性Tが出現し, 肺炎の軽快と共に異常Qは約一週間, 陰性Tは1カ月以内に正常化し, その後剖検し得た8例にはいずれも前壁中隔硬塞を認めなかった. 臨床所見では狭心痛はなく, 呼吸困難, 咳痰, チアノーゼ, 意識障害等が見られ, 肺炎は2葉以上にわたる広範な病巣を示し, 胸膜癒着または胸水を伴った. 検査所見ではGOTの軽度上昇を4例に認めたにすぎず, BUNの一過性上昇, CRP強陽性, PO2低下と共にヘマトクリットは全例4~9%の著明な上昇を示した.剖検し得た8例では肺気腫を6例, 気管支炎を7例に, 剖検時肺炎を6例に認めた. 陳旧性後壁硬塞及び後壁心外膜下出血を各1例に認めた. 左冠動脈前下行枝の50%以上狭窄を7例に認め, 心筋小胼胝を5例に認めた.急性心筋硬塞様心電図の発現機序として慢性肺疾患によるQRS軸の後方偏位, 肺炎に伴う急性右心負荷, hypoxia, 中等度の冠硬化などの上にヘマトクリット, 血液粘度の上昇等が加わって心筋に広範な一過性虚血性変化を来たすものと考えた.