Reitan J A, Kien N D, Moore P G, White D A
Department of Anesthesiology, University of California School of Medicine, Davis 95616.
Br J Anaesth. 1994 Sep;73(3):371-9. doi: 10.1093/bja/73.3.371.
During acute myocardial ischaemia, the function of the unaffected muscle is the primary determinant of residual cardiac performance. We compared six methods of measuring regional function in the remaining non-ischaemic segment after acute ligation of the left anterior descending (LAD) coronary artery in 16 dogs. Preparation included left ventricular micromanometers, regional sonomicrometer transducers to measure segment length and wall thickness, caval occluders and left atrial catheters for injection of radioactive microspheres to measure regional blood flow. Pulmonary artery, central venous and systemic arterial pressures were measured and regional coronary venous blood was collected for direct myocardial oxygen consumption (VO2) calculations. Under basal high-dose fentanyl-neuromuscular blocker anaesthesia, the LAD was occluded after addition of halothane or isoflurane at 0.5 or 1.5 MAC concentrations. Regional myocardial function of the non-ischaemic segment was assessed by the following computer-derived indices: percent systolic wall thickening (% WT), velocity of shortening (vs), percent systolic shortening (%SS), regional stroke work (RSW), regional preload recruitable stroke work (RPRSW) and regional end-systolic elastance (Ees). No index demonstrated enhanced function in the non-ischaemic segment after LAD ligation and all monitors, except Ees, were sensitive to depression of function represented by a decrease in values after administration of halothane and isoflurane (P < 0.05). Ees values increased with the addition of isoflurane and remained constant with halothane. Circulating concentrations of catecholamines were unchanged after ischaemia, while inhalation agents caused a decrease in the concentrations of adrenaline and dopamine (P < 0.05), but not noradrenaline.(ABSTRACT TRUNCATED AT 250 WORDS)
在急性心肌缺血期间,未受影响心肌的功能是残余心脏功能的主要决定因素。我们比较了16只犬左前降支(LAD)冠状动脉急性结扎后,测量剩余非缺血节段区域功能的六种方法。准备工作包括左心室微测压计、用于测量节段长度和壁厚的区域超声微测计换能器、腔静脉阻断器和左心房导管,用于注射放射性微球以测量区域血流量。测量肺动脉、中心静脉和体动脉压力,并收集区域冠状静脉血用于直接计算心肌耗氧量(VO2)。在基础高剂量芬太尼-神经肌肉阻滞剂麻醉下,在添加0.5或1.5 MAC浓度的氟烷或异氟烷后,阻断LAD。通过以下计算机得出的指标评估非缺血节段的区域心肌功能:收缩期壁增厚百分比(%WT)、缩短速度(vs)、收缩期缩短百分比(%SS)、区域搏功(RSW)、区域可募集前负荷搏功(RPRSW)和区域收缩末期弹性(Ees)。LAD结扎后,没有指标显示非缺血节段功能增强,除Ees外,所有监测指标对氟烷和异氟烷给药后数值降低所代表的功能抑制均敏感(P<0.05)。添加异氟烷后Ees值增加,添加氟烷后保持不变。缺血后儿茶酚胺的循环浓度未改变,而吸入剂导致肾上腺素和多巴胺浓度降低(P<0.05),但去甲肾上腺素浓度未降低。(摘要截短于250字)