Douglas J M, Swain M E, Slotkin T A, Smith P K, Cox J L
Department of Surgery, Duke University Medical Center, Durham, N.C. 27710.
J Thorac Cardiovasc Surg. 1990 Aug;100(2):198-209.
A newly developed procedure for total cardiac denervation employing cryosurgical techniques is described. Thirty-three dogs underwent cryosurgical cardiac denervation. Twenty-seven survived the procedure and were divided into three groups. Completeness of denervation was evaluated by recording hemodynamic responses to sodium nitroprusside-induced hypotension, phenylephrine-induced hypertension, and direct cardiac autonomic nerve stimulations acutely (group I, n = 11) and 2 weeks after denervation (group II, n = 5). Serial drug infusion studies were performed during an 8-month period in group III animals (n = 11). Myocardial biopsies for catecholamine content were done in groups II and III. Both direct and reflex hemodynamic responses to autonomic neural stimulation were abolished in the acutely denervated hearts. Furthermore, at 2 weeks, direct neural stimulation was without effect, and myocardial catecholamine content was 95% depleted (p less than 0.001). Serial drug infusion studies revealed a changing spectrum of responses, suggesting the onset of reinnervation by 8 months following the procedure. Myocardial catecholamine content was 85% depleted at that time (p less than 0.001). Cryosurgical cardiac denervation is an effective technique offering the advantages of safety, simplicity, and completeness.
本文描述了一种采用冷冻手术技术进行全心脏去神经支配的新方法。33只狗接受了冷冻手术心脏去神经支配。27只在手术后存活，并被分为三组。通过记录急性（第一组，n = 11）和去神经支配后2周（第二组，n = 5）对硝普钠诱导的低血压、去氧肾上腺素诱导的高血压以及直接心脏自主神经刺激的血流动力学反应，评估去神经支配的完整性。在第三组动物（n = 11）中，在8个月期间进行了系列药物输注研究。对第二组和第三组进行了心肌活检以测定儿茶酚胺含量。在急性去神经支配的心脏中，对自主神经刺激的直接和反射性血流动力学反应均被消除。此外，在2周时，直接神经刺激无效，心肌儿茶酚胺含量减少了95%（p < 0.001）。系列药物输注研究显示反应谱发生变化，表明手术后8个月开始重新神经支配。此时心肌儿茶酚胺含量减少了85%（p < 0.001）。冷冻手术心脏去神经支配是一种有效的技术，具有安全、简单和彻底的优点。
