利用可见光光谱法对猪心肌缺血进行体内检测。

In vivo detection of myocardial ischemia in pigs using visible light spectroscopy.

作者信息

Ho Jonathan K, Liakopoulos Oliver J, Crowley Ryan, Yezbick Aaron B, Sanchez Elizabeth, Shivkumar Kalyanam, Mahajan Aman

机构信息

Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.

出版信息

Anesth Analg. 2009 Apr;108(4):1185-92. doi: 10.1213/ane.0b013e3181951a65.

DOI:10.1213/ane.0b013e3181951a65

PMID:19299784

Abstract

BACKGROUND

Monitoring tissue oxygenation (StO(2)) by visible light spectroscopy (VLS) can identify tissue ischemia, but its feasibility for detecting myocardial ischemia is not known. We hypothesized that VLS can reliably detect changes in myocardial StO(2) in pigs subjected to acute regional or global myocardial ischemia.

METHODS

In 11 pigs, regional myocardial ischemia was created by ligation of left anterior descending artery (LAD). Myocardial StO(2) was determined from the ischemic and nonischemic left ventricular (LV) regions and compared to coronary venous saturations. Myocardial function was assessed by echocardiography. In six pigs, LV-StO(2) was measured during cardiopulmonary bypass (CPB), after cardioplegic cardiac arrest, and during CPB with inadequate myocardial protection. Additionally, right ventricular (RV)- and LV-StO(2) were assessed during acute RV pressure overload from pulmonary artery (PA) banding.

RESULTS

StO(2) baselines in pigs undergoing LAD occlusion were similar in the ischemic and nonischemic myocardium (70% +/- 8% vs 74% +/- 5%). After LAD ligation, StO(2) rapidly declined (30 s: 59% +/- 8%; 1 min:50 +/- 9; 5 min:42% +/- 4%; P < 0.05) in the ischemic myocardium. Decreases in StO(2) correlated with coronary venous saturations (r = 0.88) and were associated with myocardial dysfunction. In pigs undergoing CPB, LV-StO(2) remained unchanged with initiation of CPB or after cardioplegic cardiac arrest, but LV ischemia was detected by StO(2) after aortic cross-clamp without adequate myocardial protection. Similarly, PA banding resulted in a profound decrease of RV-StO(2) from 69% +/- 6% to 52% +/- 7% (P < 0.05) with recovery after PA release.

CONCLUSIONS

VLS is a reliable method of detecting alterations in myocardial StO(2) and can be a useful monitor for rapid identification of myocardial ischemia.

摘要

背景

通过可见光光谱法（VLS）监测组织氧合（StO₂）可识别组织缺血，但其检测心肌缺血的可行性尚不清楚。我们假设VLS能够可靠地检测急性局部或全心心肌缺血猪的心肌StO₂变化。

方法

在11头猪中，通过结扎左前降支动脉（LAD）造成局部心肌缺血。测定缺血和非缺血左心室（LV）区域的心肌StO₂，并与冠状静脉饱和度进行比较。通过超声心动图评估心肌功能。在6头猪中，在体外循环（CPB）期间、心脏停搏后以及心肌保护不足的CPB期间测量LV-StO₂。此外，在肺动脉（PA）束带导致急性右心室压力过载期间评估右心室（RV）和LV-StO₂。

结果

LAD闭塞猪的缺血和非缺血心肌的StO₂基线相似（70%±8%对74%±5%）。LAD结扎后，缺血心肌中的StO₂迅速下降（30秒：59%±8%；1分钟：50±9；5分钟：42%±4%；P<0.05）。StO₂的降低与冠状静脉饱和度相关（r=0.88），并与心肌功能障碍有关。在接受CPB的猪中，CPB开始时或心脏停搏后LV-StO₂保持不变，但在没有充分心肌保护的主动脉交叉夹闭后，StO₂检测到LV缺血。同样，PA束带导致RV-StO₂从69%±6%显著下降至52%±7%（P<0.05），PA释放后恢复。