Urrea Ramos M S, Celaya Lara S, Santibáñez Salgado J A, Lozano Torres V, Herrera Alarcón V, Estrada Dávalos S, Rucinque Acevedo F, Araya Gómez V
Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Arch Inst Cardiol Mex. 1994 Jan-Feb;64(1):67-72.
Coronary artery spasm is recognized cause of angina and circulatory collapse during the operative and early postoperative period following cardiopulmonary bypass for coronary artery surgery. We present our experience with hemodynamical collapse during cardiopulmonary bypass weaning, which were refractory to treatment with inotropics such as noradrenaline and adrenalin and vasodilators such as nitroglycerin. The electrocardiographic changes, poor answer to medical treatment following successful cardiopulmonary bypass for coronary artery surgery, good myocardial protection and complete revascularization suggested severe coronary artery spasm. We used sublingual nifedipine, achieving hemodynamical stability and stopping inotropic support and cardiopulmonary bypass. We review the literature about pathophysiologic mechanism and treatment of coronary artery spasm.
冠状动脉痉挛是冠状动脉手术体外循环期间及术后早期心绞痛和循环衰竭的公认原因。我们介绍了在体外循环撤离过程中发生血流动力学衰竭的经验，这些衰竭对去甲肾上腺素和肾上腺素等血管活性药物以及硝酸甘油等血管扩张剂治疗无效。冠状动脉手术后成功进行体外循环后出现的心电图改变、对药物治疗反应不佳、良好的心肌保护和完全血运重建提示严重冠状动脉痉挛。我们使用舌下含服硝苯地平，实现了血流动力学稳定，停止了血管活性药物支持和体外循环。我们回顾了有关冠状动脉痉挛病理生理机制和治疗的文献。
