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目的研究心脏搏动做功的规律,质疑Frank-Starling心脏定律。方法根据物理学机械做功的定义,以左心室收缩射血做功为模型对心脏收缩舒张做功活动进行讨论,然后用数学方法得出结论。结果 1作者推导出计算vvvv心脏每搏收缩舒张做功的公式“d d W=∫p1dv+(-p2)d d dv+(-p4)dV=[P1+(-P2)+P3+(-P4)]·V vs∫vs∫p3dv+vs∫vs=[P1+(-P2)+P3+(-P4)]·(EDV-ESV)”(式中,P1,P3分别代表心脏收缩时左、右心室腔内的压力;P2,P4为心脏舒张期左、右心室腔内的压力;V为每搏量;Vs和Vd为心脏收缩开始和结束,即:心脏收缩舒张做功时心室肌壁移动的区间;EDV和ESV为心脏舒张末期与收缩末期容积;dv为射出或吸入心室的血液容积增量)。2局部心室肌壁收缩做功与其肌壁收缩移动时的“ah”值成正比例(a为心脏收缩时局部心室肌壁位移动的加速度,h为其收缩时的位移)。结论 1在推导出的公式“W=[P1+(-P2)+P3+(-P4)]·(EDV-ESV)”中,心脏做功W和(EDV-ESV)与EDV三者之间的数学关系表明:W是(EDV-ESV)的函数,和单一参数EDV却没有函数关系,这就证明了心脏做功W是EDV的函数的理论(Frank-Starling心脏定律)没有理论上的必然性,它不是一个真实的定律。2超声检测某一点心室肌壁收缩活动时的“ah”值,可作为评价其心脏收缩功能的指标;舒张时的“ah”值可作为评价其舒张功能的指标。
Objective To study the law of heart beat work, question the Frank-Starling heart law. Methods According to the definition of physical mechanical work, the work of systolic and diastolic left ventricular systolic ejection was taken as a model to discuss the work activities of systolic and diastolic heart, and then the conclusion was obtained by mathematical method. RESULTS 1 The authors deduced the formula for calculating the systolic-diastolic work volume per heartbeat of vvvv “dd W = ∫ p1dv + (- p2) dd dv + (- p4) dV = [P1 + (- P2) + P3 + (- P4) ∫ vs ∫ p3dv + vs ∫vs = [P1 + (- P2) + P3 + (- P4)] (EDV-ESV) ”where P1 and P3 respectively represent the pressures in the left and right ventricular chambers during systole ; P2, P4 for the left and right ventricular diastolic heart chamber pressure; V for the stroke volume; Vs and Vd for the start and end of systole, that is: systolic and diastolic heart ventricular wall motion range; EDV and ESV For the end-diastolic and end-systolic volumes; dv is the increase in blood volume exiting or aspirating the ventricle). Local LV wall contraction work is proportional to the value of “ah ” during contraction of the muscular wall (a is the acceleration of the wall motion of the local ventricular muscle during systole and h is the displacement at systole). Conclusions 1 The relationship between the cardiac work W and (EDV-ESV) and the EDV in the derived formula “W = [P1 + (- P2) + P3 + (- P4)] The mathematical relationship shows that W is a function of (EDV-ESV) and has no functional relationship with a single parameter EDV. This proves that there is no theoretical necessity for the cardiac work W to be a function of EDV (Frank-Starling’s law of the heart) Not a real law. 2 The value of ”ah “ in detecting cardiac muscle contraction at a certain point can be used as an index to evaluate the cardiac systolic function. The ”ah" value during diastole can be used as an index to evaluate the diastolic function.