Hale S L, Kloner R A
The Heart Institute of Good Samaritan Hospital, Los Angeles, California 90017, USA.
J Cardiovasc Electrophysiol. 1999 Mar;10(3):405-13. doi: 10.1111/j.1540-8167.1999.tb00689.x.
The importance of temperature in the development of necrosis after myocardial ischemia in the beating heart is becoming apparent. Recent studies have shown that the proportion of the ischemic risk zone that becomes necrotic is directly correlated with temperature. This fact suggests the potential therapeutic benefits of reducing myocardial temperature after coronary artery occlusion. We have shown in a number of experimental protocols in the rabbit model of myocardial infarction that topical regional hypothermia reduces infarct size even when instituted after coronary artery occlusion. The reduction in myocardial temperature required to obtain this benefit is modest ( 30 degrees C to 34 degrees C). Topical regional hypothermia allows targeted cooling of a zone of the heart. Myocardial cooling can also be achieved by perfusing the pericardial sac with a chilled fluid by using a closed-circuit catheter system that does not cause cardiac tamponade. This technique also protects myocardium during ischemia. Myocardial hypothermia might be a useful technique to limit ischemic damage during infarction or as adjunctive therapy during minimally invasive cardiac surgery.
温度在跳动心脏心肌缺血后坏死发展过程中的重要性正日益显现。最近的研究表明，发生坏死的缺血危险区比例与温度直接相关。这一事实提示了冠状动脉闭塞后降低心肌温度可能带来的治疗益处。我们在兔心肌梗死模型的多项实验方案中表明，即使在冠状动脉闭塞后实施，局部区域低温也能减小梗死面积。获得这种益处所需降低的心肌温度幅度不大（30摄氏度至34摄氏度）。局部区域低温可对心脏的一个区域进行靶向降温。通过使用不会导致心脏压塞的闭路导管系统向心包腔内灌注冷液体，也可实现心肌降温。该技术在缺血期间也能保护心肌。心肌低温可能是一种在梗死期间限制缺血损伤或作为微创心脏手术辅助治疗的有用技术。
