Jaffe C C, Wohlgelernter D, Cabin H, Bowman L, Deckelbaum L, Remetz M, Cleman M
Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, CT 06510.
Am Heart J. 1988 Jun;115(6):1156-64. doi: 10.1016/0002-8703(88)90002-6.
The cardioprotective efficacy of coronary perfusion during angioplasty was evaluated. Forty-two patients underwent transcatheter infusion of oxygenated Fluosol DA, 20% emulsion (FDA-20), a perfluorocarbon oxygen transport fluid, into the distal coronary artery during balloon inflations. Left ventricular function was continuously monitored by two-dimensional echocardiography, and left ventricular ejection fraction was quantitatively analyzed from the video record by an area-length method with a validated computer algorithm. Each patient had multiple nonperfused and perfused balloon inflations lasting more than 45 seconds. Nineteen of the 42 patients also received control solutions of oxygenated Ringer's lactate and nonoxygenated FDA-20. The ejection fraction of nonperfused sequences fell from a baseline value of 57 +/- 15% to 36 +/- 14% at 45 seconds of inflation time (p less than 0.0005). Falls of similar magnitude were seen in the lactated Ringer's and nonoxygenated FDA-20 perfused balloon inflations. The ejection fraction fall was associated with a 54% rise in end-systolic volume (p less than 0.0005) and a 4% rise in end-diastolic volume (p = ns) compared to baseline. Inflations perfused with oxygenated FDA-20 showed a 45-second, left ventricular ejection fraction of 53 +/- 13% (p = ns compared to baseline), which was significantly greater (p less than 0.0001) than the 45-second ejection fraction of the nonperfused, or control solution perfused sequences. Results indicate that the profound fall in ejection fraction occurring during percutaneous transluminal coronary angioplasty can be ameliorated by distal coronary perfusion with an oxygenated perfluorocarbon emulsion.
评估了血管成形术期间冠状动脉灌注的心脏保护功效。42例患者在球囊扩张期间经导管向远端冠状动脉内输注含氧的全氟萘烷DA 20%乳剂（FDA-20），这是一种全氟化碳氧输送液。通过二维超声心动图连续监测左心室功能，并使用经过验证的计算机算法通过面积-长度法从视频记录中对左心室射血分数进行定量分析。每位患者进行多次持续超过45秒的未灌注和灌注球囊扩张。42例患者中有19例还接受了含氧乳酸林格液和未含氧FDA-20的对照溶液。未灌注序列的射血分数在扩张45秒时从基线值57±15%降至36±14%（p<0.0005）。在灌注乳酸林格液和未含氧FDA-20的球囊扩张中也观察到了类似幅度的下降。与基线相比，射血分数下降与收缩末期容积增加54%（p<0.0005）和舒张末期容积增加4%（p=无统计学意义）相关。用含氧FDA-20灌注的扩张显示45秒时左心室射血分数为53±13%（与基线相比p=无统计学意义），这显著高于（p<0.0001）未灌注或对照溶液灌注序列的45秒射血分数。结果表明，经皮冠状动脉腔内血管成形术期间发生的射血分数大幅下降可通过用含氧全氟化碳乳剂进行远端冠状动脉灌注得到改善。
