Levitsky S, Wright R N, Rao K S, Holland C, Roper K, Engelman R, Feinberg H
Surgery. 1977 Jul;82(1):51-9.
There has been considerable controversy concerning the relative merits of intermittent coronary perfusion vs. continuous aortic cross-clamping for cardiac procedures requiring ischemic arrest. Using the isovolumic ventricular balloon model and "stop-freeze" biopsy techniques, myocardial contractility (LV dp/dt max, length-tension, and force-velocity relationships) and metabolism (adenine nucleotides, creatine phosphate, and glycogen) were studied in 46 intact dogs supported by normothermic cardiopulmonary bypass and subjected to either 60 minutes of continuous ischemic arrest or to four 15-minute intervals of ischemia each followed by 5 minutes of reperfusion. Following ischemia the hearts were reperfused for 30 minutes and defibrillated after the first 10 minutes. There were no significant differences in either metabolic parameters or contractile function between the groups. Although partial regeneration of adenosine triphosphate and glycogen occurred during reperfusion, only creatine phosphate achieved normal values and the end result was no difference between the two techniques. These data indicate that 5 minutes of coronary reperfusion between consecutive episodes of ischemic arrest affords no greater intraoperative protection of the myocardium than does continuous aortic cross-clamping.
对于需要缺血性停搏的心脏手术，间歇性冠状动脉灌注与持续性主动脉交叉钳夹的相对优点一直存在相当大的争议。使用等容心室球囊模型和“停止 - 冷冻”活检技术，在46只由常温体外循环支持的完整犬中，研究了心肌收缩力（左心室dp/dt max、长度 - 张力和力 - 速度关系）和代谢（腺嘌呤核苷酸、磷酸肌酸和糖原），这些犬接受了60分钟的持续性缺血性停搏或四个15分钟的缺血间隔，每个间隔后再灌注5分钟。缺血后，心脏再灌注30分钟，并在最初10分钟后除颤。两组之间的代谢参数或收缩功能均无显著差异。虽然在再灌注期间三磷酸腺苷和糖原部分再生，但只有磷酸肌酸达到正常值，最终结果是两种技术之间没有差异。这些数据表明，与持续性主动脉交叉钳夹相比，在连续缺血性停搏发作之间进行5分钟的冠状动脉再灌注并不能在术中为心肌提供更大的保护。
