Buxton A E, Goldberg S, Harken A, Hirshfield J, Kastor J A
N Engl J Med. 1981 May 21;304(21):1249-53. doi: 10.1056/NEJM198105213042101.
We investigated coronary-artery spasm in six patents who had had unexpected hemodynamic collapse within two hours after cardiopulmonary bypass for myocardial revascularization. All six had profound hypotension and recurrent ST-segment elevation in electrocardiographic Leads II, III, and aVF. All had either normal or noncritical luminal irregularities of dominant right coronary arteries and more than 75 per cent occlusions in the left coronary circulation. Right-coronary-artery spasm, which was reversed after intracoronary nitroglycerin, was demonstrated angiographically in one patient; a patent right coronary artery was found at autopsy in another patient. Three patients died despite large intravenous doses of nitroglycerin. Two patients who had been unresponsive to intravenous nitroglycerin recovered after direct infusion of nitroglycerin into the right coronary artery. Coronary-artery spasm immediately after myocardial revascularization may cause circulatory collapse and death; although the spasm may be refractory to usual therapy, it may respond to intracoronary nitroglycerin.
我们对6例在心肌血运重建体外循环后两小时内发生意外血流动力学崩溃的患者进行了冠状动脉痉挛的调查。所有6例患者均出现严重低血压，心电图Ⅱ、Ⅲ和aVF导联ST段反复抬高。所有患者优势右冠状动脉管腔均正常或有非临界性不规则，左冠状动脉循环中存在超过75%的闭塞。1例患者经冠状动脉内注射硝酸甘油后痉挛逆转，血管造影显示为右冠状动脉痉挛；另1例患者尸检发现右冠状动脉通畅。尽管静脉注射大剂量硝酸甘油，仍有3例患者死亡。2例对静脉注射硝酸甘油无反应的患者在将硝酸甘油直接注入右冠状动脉后恢复。心肌血运重建后立即发生的冠状动脉痉挛可能导致循环衰竭和死亡；尽管这种痉挛可能对常规治疗无效，但可能对冠状动脉内注射硝酸甘油有反应。
