Fujita M, Sasayama S, Ohno A, Yamanishi K, Araie E, Franklin D
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
Int J Cardiol. 1990 May;27(2):179-86. doi: 10.1016/0167-5273(90)90157-z.
The purpose of this study was to evaluate the effects of myocardial ischemia on the development of collateral circulation. Thirteen conscious dogs were instrumented for serial measurements of subendocardial segment length in the area perfused by the left circumflex coronary artery, left circumflex coronary artery flow and left ventricular pressure. In 6 dogs (group A), 1 min left circumflex coronary artery occlusions were carried out at 30 min intervals. When the 442nd 1 min left circumflex coronary artery occlusion produced a reduction in segment shortening and a significant reactive hyperemia, the occlusion time was increased to 2 min. In the remaining 7 dogs (group B), 2 min left circumflex coronary artery occlusions were conducted hourly. In group A, following 451 +/- 201 (SD) min of total occlusion time with the mixture of 1 and 2 min left circumflex coronary artery occlusions (43 +/- 18 days) a left circumflex coronary artery occlusion produced no reduction in segment shortening and negligible reactive hyperemia. By contrast, in group B, 218 +/- 99 min of total occlusion time (18 +/- 8 days) was required to develop adequate collateral circulation. The relative contribution of the first and second 1 min of left circumflex coronary artery occlusion to the collateral development was mathematically evaluated. This analysis indicated that the second 1 min of left circumflex coronary artery occlusion is 4.43-fold more effective than the first 1 min of occlusion in terms of the collateral induction. We concluded that severe myocardial ischemia plays an important role in the development of collateral circulation.
本研究的目的是评估心肌缺血对侧支循环发育的影响。对13只清醒犬进行仪器植入，以连续测量左旋冠状动脉灌注区域的心内膜下节段长度、左旋冠状动脉血流量和左心室压力。在6只犬（A组）中，每隔30分钟进行1分钟的左旋冠状动脉闭塞。当第442次1分钟的左旋冠状动脉闭塞导致节段缩短减少和显著的反应性充血时，闭塞时间增加到2分钟。在其余7只犬（B组）中，每小时进行2分钟的左旋冠状动脉闭塞。在A组中，在总闭塞时间为451±201（标准差）分钟（43±18天）的1分钟和2分钟左旋冠状动脉闭塞混合操作后，一次左旋冠状动脉闭塞未导致节段缩短减少，反应性充血可忽略不计。相比之下，在B组中，需要218±99分钟的总闭塞时间（18±8天）来建立充分的侧支循环。对左旋冠状动脉闭塞的第一个1分钟和第二个1分钟对侧支循环发育的相对贡献进行了数学评估。该分析表明，就侧支循环诱导而言，左旋冠状动脉闭塞的第二个1分钟比第一个1分钟有效4.43倍。我们得出结论，严重心肌缺血在侧支循环发育中起重要作用。
