Tydén H, Johansson L, Nyström S O
Acta Anaesthesiol Scand. 1979 Oct;23(5):493-502. doi: 10.1111/j.1399-6576.1979.tb01478.x.
Haemodynamic adaptation was studied during the first 10 h after aorto-coronary bypass surgery. In a control group of 12 patients the heart was fibrillating and perfused during cardiopulmonary bypass (at 30 degrees C), and in 11 patients cold cardioplegic arrest was used. The first 4--5 h were characterized by rewarming, with increasing oesophageal temperature, cutaneous vasoconstriction and elevated systemic vascular resistance (SVR). A phase of vasodilation followed. In the control group the oxygen uptake index increased by 57% during rewarming, but the cardiac index (CI) was constant (about 2.9 l . min-1.m-2). The arterio-venous oxygen content difference (AVDo2) therefore increased (max. 3.0 mmol . l-1). The postoperative left ventricular performance was better and the serum levels of aspartate aminotransferase (ASAT) during the first 2 days postoperatively were lower in the cardioplegic patients than in the controls, indicating more efficient myocardial preservation. In the cardioplegic-hypothermic group, CI was constant at about 3.2 l . min-1.m-2 (significantly higher than in the control group) and AVDo2 remained normal during the rewarming period. The heart rate was lower initially in the cardioplegic patients than in the controls, implying a favourable influence on myocardial oxygen consumption. The better myocardial function in the cardioplegic-hypothermic group was associated with an only moderately increased SVR. This suggests that the elevated SVR in the control group could have been due to myocardial depression.
对主动脉冠状动脉搭桥手术后最初10小时内的血流动力学适应性进行了研究。在一个由12名患者组成的对照组中，体外循环期间（30℃）心脏处于颤动并进行灌注，11名患者则采用了心脏冷停搏术。最初4 - 5小时的特点是复温，食管温度升高、皮肤血管收缩和全身血管阻力（SVR）升高。随后是血管舒张期。在对照组中，复温期间氧摄取指数增加了57%，但心脏指数（CI）保持恒定（约2.9升·分钟⁻¹·米⁻²）。因此动静脉氧含量差（AVDo2）增加（最高达3.0毫摩尔·升⁻¹）。心脏停搏患者术后左心室功能更好，术后前两天的天冬氨酸转氨酶（ASAT）血清水平低于对照组，这表明心肌保护更有效。在心脏停搏低温组中，CI恒定在约3.2升·分钟⁻¹·米⁻²（显著高于对照组），复温期间AVDo2保持正常。心脏停搏患者的心率最初低于对照组，这意味着对心肌氧消耗有有利影响。心脏停搏低温组较好的心肌功能与SVR仅适度升高有关。这表明对照组中SVR升高可能是由于心肌抑制所致。
