Young L H, Jaffe C C, Revkin J H, McNulty P H, Cleman M
Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut.
Am J Cardiol. 1990 Apr 15;65(15):986-90. doi: 10.1016/0002-9149(90)91001-m.
Myocardial lactate metabolism and left ventricular function were studied in 12 patients during angioplasty of the left anterior descending artery performed with distal coronary perfusion (oxygenated and nonoxygenated Fluosol) and by conventional technique without distal perfusion. Before balloon inflation there was net lactate extraction by the heart (31 +/- 6%). During balloon inflations performed with distal perfusion there was net lactate release into the great cardiac vein while the balloon was inflated; the great cardiac vein lactate concentration was approximately 25% lower during perfusion with oxygenated versus nonoxygenated Fluosol (p less than 0.02) indicating less myocardial lactate release. After balloon deflation washout of lactate into the great cardiac vein (net myocardial release) was observed in all 3 protocols. Left ventricular ejection fraction measured by echocardiography decreased markedly during nonperfused (53 +/- 3 to 36 +/- 3%, p less than 0.001) and nonoxygenated Fluosol (52 +/- 2 to 30 +/- 3%, p less than 0.001) inflations. This dysfunction was largely prevented by oxygenated Fluosol where only a minimal decrease in ejection fraction (51 +/- 2 vs 48 +/- 2%, p less than 0.02) occurred. Analysis of regional contractile function yielded similar results. Although oxygenated perfluorocarbons decrease cardiac lactate release during angioplasty, this study provides evidence for the onset of lactate production even when ventricular function is preserved.
在12例患者进行左前降支血管成形术时，研究了心肌乳酸代谢和左心室功能。血管成形术采用远端冠状动脉灌注（充氧和未充氧的氟碳化合物）和无远端灌注的传统技术。在球囊扩张前，心脏有净乳酸摄取（31±6%）。在采用远端灌注进行球囊扩张时，球囊扩张期间有净乳酸释放到冠状大静脉；与未充氧的氟碳化合物灌注相比，充氧的氟碳化合物灌注期间冠状大静脉乳酸浓度约低25%（p<0.02），表明心肌乳酸释放较少。在所有3种方案中，球囊放气后均观察到乳酸被冲洗到冠状大静脉（心肌净释放）。通过超声心动图测量的左心室射血分数在未灌注（53±3至36±3%，p<0.001）和未充氧的氟碳化合物灌注（52±2至30±3%，p<0.001）期间显著降低。充氧的氟碳化合物在很大程度上预防了这种功能障碍，此时射血分数仅略有下降（51±2对48±2%，p<0.02）。区域收缩功能分析得出了类似的结果。尽管充氧的全氟化碳在血管成形术期间减少了心脏乳酸释放，但本研究为即使心室功能得以保留时乳酸生成的开始提供了证据。
