Mori F, Ivey T D, Itoh T, Thomas R, Breazeale D G, Misbach G
J Thorac Cardiovasc Surg. 1987 May;93(5):719-27.
It has been postulated that pulsatile blood flow helps to preserve the myocardium after ischemia. However, its effect on postischemic myocardium during cardiopulmonary bypass has not been clearly defined. To determine if pulsatile reperfusion improves postischemic recovery of cardiac metabolism and performance, we subjected 20 dogs to 60 minutes of aortic cross-clamping followed by 45 minutes of pulsatile (P group; 10 dogs) or nonpulsatile (NP group; 10 dogs) reperfusion. Left ventricular function was measured at a controlled preload in both groups before induction of global ischemia and after termination of bypass. Segmental length (assessed by sonomicrometry) was used to determine dimensional changes. Ventricular pressures were measured with solid-state micromanometers. Percent recovery of left ventricular peak systolic pressure, its first derivative, and stroke work were 66%, 59%, and 38%, respectively in the NP group and 82%, 76%, and 65% in the P group. The postarrest decrease in segmental shortening was minimized in the P group; left ventricular function curves and the slope of the end-systolic pressure-length relationship also indicated better performance after pulsatile reperfusion than after nonpulsatile reperfusion. Myocardial lactate extraction was transiently improved during the early pulsatile reperfusion period. We conclude that pulsatile reperfusion provides better myocardial preservation than nonpulsatile perfusion after 60 minutes of induced global ischemia.
据推测，搏动性血流有助于在缺血后保护心肌。然而，其在体外循环期间对缺血后心肌的影响尚未明确界定。为了确定搏动性再灌注是否能改善缺血后心脏代谢和功能的恢复，我们将20只犬进行60分钟的主动脉交叉钳夹，然后分别进行45分钟的搏动性再灌注（P组，10只犬）或非搏动性再灌注（NP组，10只犬）。在诱导全心缺血前和体外循环结束后，在两组的可控前负荷下测量左心室功能。采用声控微测法评估节段长度以确定尺寸变化。用固态微测压计测量心室压力。NP组左心室收缩压峰值、其一阶导数和每搏功的恢复百分比分别为66%、59%和38%，P组分别为82%、76%和65%。P组中，心脏骤停后节段缩短的减少最小化；左心室功能曲线和收缩末期压力-长度关系的斜率也表明，搏动性再灌注后的性能优于非搏动性再灌注。在搏动性再灌注早期，心肌乳酸摄取暂时改善。我们得出结论，在诱导全心缺血60分钟后，搏动性再灌注比非搏动性灌注能提供更好的心肌保护。
