Klein H O, Brodsky E, Ninio R, Kaplinsky E, Di Segni E
Department of Cardiology, Meir General Hospital, Sapir Medical Center, Kfar-Saba, Israel.
Chest. 1993 Feb;103(2):521-7. doi: 10.1378/chest.103.2.521.
Rotating tourniquets were once part of the traditional treatment of acute pulmonary edema. Their effectiveness has been questioned and vasodilator therapy has replaced them, but early favorable results suggested that they may play a beneficial role. A radioisotope technique was used to evaluate blood volume increments in the leg after venous occlusion at 60 mm Hg in 26 patients with left ventricular dysfunction following myocardial infarction. Mean radionuclide counts (reflecting the blood volume distal to the occlusion) increased from the preocclusion value. Thus, satisfactory trapping of blood is achieved. However, mean left ventricular ejection fraction (EF) decreased slightly but significantly and this decrease in EF was observed in 18 of 26 patients. Left ventricular end-diastolic and end-systolic volume equivalents tended to decrease slightly but not in all patients. Mean stroke volume and cardiac output equivalents were reduced by 14 percent while peripheral resistance increased significantly. The present study thus fails to support the hypothesis that preload reduction by tourniquets improves left ventricular function; the exact opposite effect may occur because of increased afterload.
旋转止血带曾是急性肺水肿传统治疗方法的一部分。其有效性受到质疑，血管扩张剂疗法已取而代之，但早期的良好效果表明它们可能发挥有益作用。采用放射性同位素技术评估了26例心肌梗死后左心室功能不全患者在60毫米汞柱静脉闭塞后腿部血容量的增加情况。平均放射性核素计数（反映闭塞远端的血容量）较闭塞前值增加。因此，实现了血液的满意截留。然而，平均左心室射血分数（EF）略有但显著下降，26例患者中有18例出现了这种EF下降情况。左心室舒张末期和收缩末期容积当量往往略有下降，但并非所有患者都如此。平均每搏量和心输出量当量减少了14%，而外周阻力显著增加。因此，本研究未能支持止血带降低前负荷可改善左心室功能这一假说；由于后负荷增加，可能会出现完全相反的效果。
