Landymore R W, Marble A E, Eng P, MacAulay M A, Trillo A, Li Q Y
Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Eur J Cardiothorac Surg. 1991;5(8):395-9. doi: 10.1016/1010-7940(91)90182-j.
The effects of high-volume cardioplegia on the presence of small-amplitude electrical activity during cardioplegia arrest were investigated in 19 mongrel dogs. The animals were randomly assigned to receive either high-volume crystalloid cardioplegia (HV-plege) or crystalloid cardioplegia guided by continuous electrical monitoring (V-plege). Cardiac index, left ventricular stroke work index dp/dt, and myocardial oxygen consumption were measured before bypass and following 90 min ischemia and 45 min reperfusion. Biopsies were taken for measurement of adenosine triphosphate (ATP) and examination of myocardial ultrastructure. Nine animals received HV-plege, while the remaining 10 animals received cardioplegia guided by voltage criteria. Small-amplitude electrical potentials were recorded within 10-15 min after the infusion of cardioplegia in all animals receiving cardioplegia guided by voltage criteria. Electrical activity, however, was immediately abolished by reinfusion of cardioplegia. HV-plege reduced the incidence of small-amplitude electrical activity during cardioplegia arrest but did not prevent electrical activity. Left ventricular function and myocardial ultrastructure were better preserved when cardioplegia was guided by electrical monitoring. ATP decreased similarly in both groups following cardioplegic arrest, but myocardial oxygen consumption was significantly higher following the arrest in the V-plege group.
HV-plege does not prevent small-amplitude electrical activity and may have adverse effects on myocardial metabolic and functional recovery.
在19只杂种犬中研究了大容量心脏停搏液对心脏停搏期间小幅度电活动存在情况的影响。动物被随机分配接受大容量晶体心脏停搏液（HV-停搏液）或连续电监测指导下的晶体心脏停搏液（V-停搏液）。在体外循环前、90分钟缺血和45分钟再灌注后测量心脏指数、左心室每搏功指数dp/dt和心肌耗氧量。取活检组织测量三磷酸腺苷（ATP）并检查心肌超微结构。9只动物接受HV-停搏液，其余10只动物接受电压标准指导下的心脏停搏液。在所有接受电压标准指导的心脏停搏液的动物中，在注入心脏停搏液后10-15分钟内记录到小幅度电位。然而，通过再次注入心脏停搏液可立即消除电活动。HV-停搏液降低了心脏停搏期间小幅度电活动的发生率，但并未防止电活动。当心脏停搏液由电监测指导时，左心室功能和心肌超微结构得到更好的保存。心脏停搏后两组的ATP下降相似，但V-停搏液组心脏停搏后心肌耗氧量明显更高。
HV-停搏液不能防止小幅度电活动，可能对心肌代谢和功能恢复有不利影响。
