Nanas Serafim, Gerovasili Vasiliki, Dimopoulos Stavros, Pierrakos Charalampos, Kourtidou Soultana, Kaldara Elissavet, Sarafoglou Serafim, Venetsanakos John, Roussos Charis, Nanas John, Anastasiou-Nana Maria
Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, Athens, Greeece.
J Card Fail. 2008 Jun;14(5):400-6. doi: 10.1016/j.cardfail.2008.02.001.
Skeletal muscle microcirculation impairment in patients with chronic heart failure (CHF) seems to correlate with disease severity. We evaluated the microcirculation by near-infrared spectroscopy (NIRS) occlusion technique before and after inotropic infusion.
We evaluated 25 patients with stable CHF, 30 patients with end-stage CHF (ESCHF) receiving treatment with intermittent infusion of inotropic agents, and 12 healthy subjects. Thenar muscle tissue oxygen saturation (StO(2)%) was measured noninvasively by NIRS before, during, and after 3-minute occlusion of the brachial artery (occlusion technique) in all subjects and in patients with ESCHF before and after 6 hours of inotropic infusion (dobutamine and/or levosimendan) or placebo (N = 5).
Patients with ESCHF or CHF presented significantly lower StO(2)% than healthy subjects (74.5% +/- 7%, 78.6% +/- 6%, and 85% +/- 5%, respectively; P = .0001), lower oxygen consumption rate during occlusion (24.6% +/- 8%/min, 28.6% +/- 10%/min, and 38.1% +/- 11.1%/min, respectively; P = .001), and lower reperfusion rate (327% +/- 141%/min, 410% +/- 106%/min, and 480% +/- 133%/min, respectively; P = .002). After 6 hours of inotropic infusion, patients with ESCHF showed significantly increased StO(2)% (74.5% +/- 7% to 82% +/- 9%, P = .001), oxygen consumption rate (24.6% +/- 8%/min to 29.3% +/- 8%/min, P = .009), and reperfusion rate (327% +/- 141%/min to 467% +/- 151%/min, P = .001). No statistical difference was noted in the placebo group.
Peripheral muscle microcirculation as assessed by NIRS is impaired in patients with CHF. This impairment is partially reversed by infusion of inotropic agents in patients with ESCHF.
慢性心力衰竭（CHF）患者的骨骼肌微循环障碍似乎与疾病严重程度相关。我们通过近红外光谱（NIRS）闭塞技术评估了在给予正性肌力药物输注前后的微循环情况。
我们评估了25例稳定型CHF患者、30例接受间歇性正性肌力药物输注治疗的终末期CHF（ESCHF）患者以及12名健康受试者。在所有受试者中，通过NIRS在肱动脉3分钟闭塞前、闭塞期间和闭塞后无创测量鱼际肌组织氧饱和度（StO₂%）；在ESCHF患者中，在给予6小时正性肌力药物输注（多巴酚丁胺和/或左西孟旦）或安慰剂（N = 5）前后进行测量。
ESCHF或CHF患者的StO₂%显著低于健康受试者（分别为74.5%±7%、78.6%±6%和85%±5%；P = .0001），闭塞期间的氧消耗率较低（分别为24.6%±8%/分钟、28.6%±10%/分钟和38.1%±11.1%/分钟；P = .001），再灌注率也较低（分别为327%±141%/分钟、410%±106%/分钟和480%±133%/分钟；P = .002）。在给予6小时正性肌力药物输注后，ESCHF患者的StO₂%显著升高（从74.5%±7%升至82%±9%，P = .001），氧消耗率升高（从24.6%±8%/分钟升至29.3%±8%/分钟，P = .009），再灌注率升高（从327%±141%/分钟升至467%±151%/分钟，P = .001）。安慰剂组未观察到统计学差异。
通过NIRS评估的CHF患者外周肌肉微循环受损。在ESCHF患者中，正性肌力药物输注可部分逆转这种损害。
