Fiedler V B
Res Exp Med (Berl). 1981;179(3):183-98. doi: 10.1007/BF01851615.
Isolated canine hearts with a critical stenosis on one coronary artery were perfused for 2 h with blood from supporting dogs using a new roller pump system that can deliver pulsatile or non-pulsatile flow perfusion. Non-pulsatile perfusion caused a decrease in coronary venous oxygen tension of 22% (P less than 0.05) accompanied by increasing carbon dioxide tension of 50% (P less than 0.02). With pulsatile flow coronary venous oxygen and carbon dioxide tensions remained stable. Non-pulsatile perfusion decreased the coronary arteriovenous oxygen difference by 35% (P less than 0.02), coronary blood flow by 40% (P less than 0.02), and myocardial oxygen consumption by 54% (P less than 0.01) whereas pulsatile flow did not change any of these variables. Subendocardial blood flow distal to the stenosis fell by 0.15 +/- 0.04 ml/min per gram myocardium (mean +/- S.E.M.) (P less than 0.01) during linear perfusion. The endocardial/epicardial-flow ratio was less than one and decreased further during fibrillation period indicating underperfusion of the endocardial muscle region. With pulsatile flow subendocardial flow remained unaltered during the two hours of fibrillation. Edema formation was 24% in hearts subjected to non-pulsatile flow but only 14% in hearts perfused by pulsatile perfusion (P less than 0.05). Accordingly, the ischemic area involved 40% of the left ventricle during non-pulsatile flow but 25% of the left ventricle in hearts perfused by pulsatile perfusion (P less than 0.05). The results indicate that pulsatile flow perfusion may prevent severe hemodynamic, hematologic, and metabolic alterations in fibrillating isolated canine hearts. It is suggested that pulsatile perfusion may be useful for fibrillating hearts during open heart surgery.
使用一种新型滚压泵系统，该系统能够进行搏动性或非搏动性血流灌注，将来自供血犬的血液灌注到一条冠状动脉存在严重狭窄的离体犬心脏中2小时。非搏动性灌注导致冠状静脉血氧张力降低22%（P<0.05），同时二氧化碳张力升高50%（P<0.02）。采用搏动性血流时，冠状静脉血氧和二氧化碳张力保持稳定。非搏动性灌注使冠状动静脉氧差降低35%（P<0.02），冠状动脉血流量降低40%（P<0.02），心肌耗氧量降低54%（P<0.01），而搏动性血流未改变这些变量中的任何一个。在线性灌注期间，狭窄远端的心内膜下血流量每克心肌下降0.15±0.04毫升/分钟（平均值±标准误）（P<0.01）。心内膜/心外膜血流比值小于1，在颤动期进一步降低，表明心内膜心肌区域灌注不足。采用搏动性血流时，心内膜下血流在颤动的两小时内保持不变。非搏动性血流灌注的心脏水肿形成率为24%，而搏动性灌注的心脏水肿形成率仅为14%（P<0.05）。因此，非搏动性血流灌注时缺血区域累及左心室的40%，而搏动性灌注的心脏缺血区域累及左心室的25%（P<0.05）。结果表明，搏动性血流灌注可能预防颤动的离体犬心脏出现严重的血流动力学、血液学和代谢改变。提示搏动性灌注可能对心脏直视手术中颤动的心脏有用。
