Kleen M, Habler O, Meisner F, Kemming G, Pape A, Messmer K
Institute for Surgical Research, University of Munich, 81366 Munich, Germany.
J Appl Physiol (1985). 2000 Feb;88(2):373-85. doi: 10.1152/jappl.2000.88.2.373.
Hemorrhagic shock alters heterogeneity of regional myocardial perfusion (RMP) in the presence of critical coronary stenosis in pigs. Conventional resuscitation has failed to reverse these effects. We hypothesized that improvement of the resuscitation regime would lead to restoration of RMP heterogeneity. Diaspirin-cross-linked hemoglobin (10 g/dl; DCLHb) and human serum albumin (8.0 g/dl; HSA) were used. After baseline, a branch of the left coronary artery was stenosed; thereafter, hemorrhagic shock was induced. Resuscitation was performed with either DCLHb or HSA. At baseline, the fractcal dimension (D) of subendocardial myocardium was 1.31 +/- 0.083 (HSA) and 1.35 +/- 0.106 (DCLHb) (mean +/- SD). Coronary stenosis increased subendocardial D slightly but consistently only in the DCLHb group (1.39 +/- 0.104; P < 0.05). Shock reduced subendocardial D: 1.21 +/- 0.093 (HSA; P = 0.10), 1.25 +/- 0.092 (DCLHb; P < 0.05). Administration of DCLHb increased subendocardial D in 7 of 10 animals (1.31 +/- 0.097; P = 0.066). HSA was ineffective in this respect. DCLHb infusion restored arterial pressure and increased cardiac index (CI) to 80% of baseline values. Administration of HSA left animals hypotensive (69 mmHg) and increased CI to 122% of the average baseline value. Shock-induced disturbances of the distribution of RMP were improved by administration of DCLHb but not by HSA.
在猪存在严重冠状动脉狭窄的情况下，失血性休克会改变局部心肌灌注（RMP）的异质性。传统复苏未能逆转这些影响。我们假设改善复苏方案将导致RMP异质性的恢复。使用了双阿司匹林交联血红蛋白（10 g/dl；DCLHb）和人血清白蛋白（8.0 g/dl；HSA）。在基线后，左冠状动脉的一个分支被狭窄；此后，诱导失血性休克。用DCLHb或HSA进行复苏。在基线时，心内膜下心肌的分形维数（D）为1.31±0.083（HSA）和1.35±0.106（DCLHb）（平均值±标准差）。冠状动脉狭窄仅在DCLHb组中使心内膜下D略有但持续增加（1.39±0.104；P<0.05）。休克降低了心内膜下D：1.21±0.093（HSA；P = 0.10），1.25±0.092（DCLHb；P<0.05）。给予DCLHb使10只动物中的7只心内膜下D增加（1.31±0.097；P = 0.066）。HSA在这方面无效。输注DCLHb恢复了动脉压并使心脏指数（CI）增加到基线值的80%。给予HSA使动物血压降低（69 mmHg）并使CI增加到平均基线值的122%。给予DCLHb改善了休克引起的RMP分布紊乱，但HSA没有。
