Sheu S H, Hwang M H, Piao Z E, Hariman R J, Loeb H S, Scanlon P J
Section of Cardiology, Hines VA Hospital, Illinois 60141.
Cathet Cardiovasc Diagn. 1991 Jun;23(2):144-49. doi: 10.1002/ccd.1810230220.
Hemodynamic changes due to intracoronary injections of nonionic contrast medium Omnipaque-350 (OM), ionic dimer Hexabrix (HB), and ionic contrast medium Renografin-76 (R76) were compared at baseline and during reperfusion after a 30-minute left anterior descending coronary artery (LAD) occlusion. In 11 open chest, anesthetized, and atrially paced dogs, 4 ml of either OM, HB, R76, or 0.9% NaCl were injected into the carotid-LAD bypass system. Coronary blood flow (CBF) and coronary vascular resistance (CVR) were measured before, during and after the intracoronary injection. The maximal hyperemic change (in percentage) from the preinjection value of CBF and CVR were calculated. The results at baseline and during reperfusion for CBF were: 104 +/- 14% vs. 85 +/- 10% for OM (NS); 76 +/- 11% vs. 39 +/- 9% for R76 (p less than 0.05); 57 +/- 8% vs. 33 +/- 5% for HB (P less than 0.05); and 30 +/- 7% vs. 9 +/- 4% for 0.9% NaCl (p less than 0.05). Consequently, the hyperemic changes of CVR at baseline and during reperfusion were: -49 +/- 3 vs. -42 +/- 4% for OM (NS); -44 +/- 3% vs. -24 +/- 6% for R76 (p less than 0.01); -36 +/- 3% vs. -24 +/- 4% for HB (p less than 0.05); and -18 +/- 4% vs. -7 +/- 3% for 0.9% NaCl (p less than 0.05). Thus, ischemia and reperfusion significantly dampened the coronary hemodynamic and vascular response to R76, HB, and 0.9% NaCl but not to OM. The preserved coronary vascular reserve with high flow in this canine post-ischemic reperfusion model may explain the advantage of nonionic over ionic contrast media used in emergency coronary angiography following thrombolysis.
在左前降支冠状动脉（LAD）闭塞30分钟后的基线期和再灌注期间，比较了冠状动脉内注射非离子型造影剂欧乃派克-350（OM）、离子二聚体泛影葡胺（HB）和离子型造影剂泛影葡胺-76（R76）引起的血流动力学变化。在11只开胸、麻醉并心房起搏的犬中，将4毫升的OM、HB、R76或0.9%氯化钠注入颈动脉-LAD旁路系统。在冠状动脉内注射前、注射期间和注射后测量冠状动脉血流量（CBF）和冠状动脉血管阻力（CVR）。计算CBF和CVR相对于注射前值的最大充血变化（百分比）。CBF在基线期和再灌注期间的结果为：OM分别为104±14%和85±10%（无显著差异）；R76分别为76±11%和39±9%（p<0.05）；HB分别为57±8%和33±5%（P<0.05）；0.9%氯化钠分别为30±7%和9±4%（p<0.05）。因此，CVR在基线期和再灌注期间的充血变化为：OM分别为-49±3和-42±4%（无显著差异）；R76分别为-44±3%和-24±6%（p<0.01）；HB分别为-36±3%和-24±4%（p<0.05）；0.9%氯化钠分别为-18±4%和-7±3%（p<0.05）。因此，缺血和再灌注显著减弱了冠状动脉对R76、HB和0.9%氯化钠的血流动力学和血管反应，但对OM没有影响。在这个犬类缺血后再灌注模型中，高流量下保留的冠状动脉血管储备可能解释了在溶栓后急诊冠状动脉造影中使用非离子型造影剂优于离子型造影剂的优势。
