Rousou J H, Engelman R M, Dobbs W A, Meeran M K
Ann Thorac Surg. 1982 Apr;33(4):385-90. doi: 10.1016/s0003-4975(10)63234-1.
A study was undertaken to evaluate the effect of acute occlusion of a coronary artery during cardioplegic arrest on myocardial preservation and to elucidate the influence of reestablishment of flow versus continued occlusion during the phase of myocardial reperfusion. Coronary occlusion was simulated, and myocardial viability was determined by measuring tissue levels of adenosine triphosphate (ATP) and creatine phosphate (CP) in biopsies of the posterior left ventricular wall. Eighteen pigs were divided into three equal groups consisting of animals with (1) patent right coronary arteries during arrest and reperfusion, (2) occluded right coronary arteries during arrest and patent during reperfusion, and (3) occluded right coronary arteries during arrest and reperfusion. The results of ATP and CP measurements showed that while poorer protection was afforded during two-hour arrest when the coronary artery was occluded, the risk of damage was much greater during reperfusion. Failure to restore adequate blood flow by retention of occlusion caused a concurrent decrease in ATP and CP levels below prescribed limits of myocardial tolerance. When occlusion occurs in the clinical setting, impeding cardioplegia and reperfusion, the importance of revascularization is emphasized.
开展了一项研究，以评估心脏停搏期间冠状动脉急性闭塞对心肌保护的影响，并阐明心肌再灌注阶段血流重建与持续闭塞的影响。模拟冠状动脉闭塞，通过测量左心室后壁活检组织中三磷酸腺苷（ATP）和磷酸肌酸（CP）的组织水平来确定心肌活力。18只猪被分成三组，每组数量相等，分别为：（1）心脏停搏和再灌注期间右冠状动脉通畅的动物；（2）心脏停搏期间右冠状动脉闭塞、再灌注期间通畅的动物；（3）心脏停搏和再灌注期间右冠状动脉闭塞的动物。ATP和CP测量结果表明，冠状动脉闭塞时两小时心脏停搏期间心肌保护较差，但再灌注期间损伤风险大得多。因持续闭塞未能恢复足够血流导致ATP和CP水平同时降至心肌耐受规定限度以下。当临床发生闭塞、影响心脏停搏和再灌注时，强调血运重建的重要性。
