Priebe H J
Department of Anesthesia/University Hospital, Freiburg, Germany.
Anesthesiology. 1993 Mar;78(3):541-52. doi: 10.1097/00000542-199303000-00018.
Previously, it was suggested that right ventricular (RV) free wall dysfunction does not necessarily elicit global hemodynamic alterations. This was investigated in a canine model of halothane-induced right coronary artery (RCA) insufficiency.
Two concentrations (0.8% and 1.6% end tidal) of halothane on global and regional RV and left ventricular (LV) performance and on coronary, pulmonary, and systemic hemodynamics were studied in 10 open-chest dogs first before and, subsequently, during critical RCA stenosis.
In the absence of stenosis, halothane caused progressive and comparable depression of regional and global RV and LV function and reduction of RCA flow. Halothane administered during RCA stenosis caused disproportionate decreases in RCA flow and segment shortening and increases in systolic segment lengths in the area supplied by the stenosed RCA that were approximately twice as great as before stenosis. Such severe regional RV dysfunction was not accompanied by greater depression of global RV and LV pump function (systolic pressures and stroke volume).
In the canine heart with its dominant left coronary system, RCA insufficiency (on the basis of halothane-induced hypotension) caused regional RV dysfunction suggesting ischemia that was not accompanied by global hemodynamic alteration.
此前有研究表明,右心室(RV)游离壁功能障碍不一定会引发整体血流动力学改变。本研究在氟烷诱导的犬右冠状动脉(RCA)供血不足模型中对此进行了探究。
对10只开胸犬,先在无RCA狭窄时,随后在RCA严重狭窄期间,研究了两种浓度(呼气末浓度分别为0.8%和1.6%)的氟烷对RV和左心室(LV)整体及局部功能,以及对冠状动脉、肺和全身血流动力学的影响。
在无狭窄时,氟烷导致RV和LV局部及整体功能逐渐且同等程度地降低,以及RCA血流量减少。在RCA狭窄期间给予氟烷,导致RCA血流量和节段缩短不成比例地减少,且狭窄RCA供血区域的收缩期节段长度增加,增加幅度约为狭窄前的两倍。如此严重的RV局部功能障碍并未伴随RV和LV整体泵功能(收缩压和每搏输出量)更明显的降低。
在以左冠状动脉系统为主的犬心脏中,RCA供血不足(基于氟烷诱导的低血压)导致RV局部功能障碍,提示存在缺血,但未伴随整体血流动力学改变。