Blomberg S, Emanuelsson H, Kvist H, Lamm C, Pontén J, Waagstein F, Ricksten S E
Department of Anesthesia and Intensive Care, University of Gothenburg, Sahlgren's Hospital, Sweden.
Anesthesiology. 1990 Nov;73(5):840-7. doi: 10.1097/00000542-199011000-00008.
The effect of cardiac sympathetic blockade by high thoracic epidural anesthesia (TEA) (T1-T6, bupivacaine) on the luminal diameter of normal and diseased portions of epicardial coronary arteries was determined by quantitative coronary angiography in patients (n = 27) with severe coronary artery disease (CAD). In a separate group of patients (n = 9) with severe CAD, the effects of TEA on coronary arterioles (resistance vessels) were studied, by measuring total and regional myocardial blood flow and metabolism with the retrograde coronary sinus thermodilution technique. At the stenotic segments, TEA induced an increase in luminal diameter from 1.34 +/- 0.11 to 1.56 +/- 0.13 mm (P less than 0.002), but did not change the diameter of the nonstenotic segments (3.07 +/- 0.13 to 2.99 +/- 0.13 mm). In the second group of patients, TEA induced no changes in coronary perfusion pressure, total or regional myocardial blood flow, coronary venous oxygen content, coronary blood flow distribution, regional myocardial oxygen consumption, or lactate extraction or uptake. Two patients had chest pain in the control situation and had regional myocardial lactate production that was attenuated by TEA. We conclude that TEA may increase the diameter of stenotic epicardial coronary artery segments in patients with CAD without causing a dilation of coronary arterioles. These effects may be beneficial when high TEA is used to treat severe ischemic chest pain in patients at rest.
通过对27例严重冠状动脉疾病（CAD）患者进行定量冠状动脉造影，确定了高胸段硬膜外麻醉（TEA）（T1 - T6，布比卡因）对心外膜冠状动脉正常和病变部位管腔直径的影响。在另一组9例严重CAD患者中，采用逆行冠状窦热稀释技术测量全心和局部心肌血流及代谢，研究了TEA对冠状动脉小动脉（阻力血管）的影响。在狭窄节段，TEA使管腔直径从1.34±0.11 mm增加到1.56±0.13 mm（P＜0.002），但未改变非狭窄节段的直径（从3.07±0.13 mm到2.99±0.13 mm）。在第二组患者中，TEA未引起冠状动脉灌注压、全心或局部心肌血流、冠状静脉血氧含量、冠状动脉血流分布、局部心肌氧耗量或乳酸摄取或生成的改变。两名患者在对照情况下有胸痛，局部心肌乳酸生成经TEA后减弱。我们得出结论，TEA可能增加CAD患者狭窄的心外膜冠状动脉节段的直径，而不引起冠状动脉小动脉扩张。当使用高胸段TEA治疗静息状态下的严重缺血性胸痛患者时，这些作用可能有益。
