Schlack W, Thämer V
Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität Düsseldorf, Germany.
Acta Anaesthesiol Scand. 1996 Feb;40(2):262-71. doi: 10.1111/j.1399-6576.1996.tb04430.x.
Different regions within the left ventricle are preferentially supplied by the left or right sympathetic system. In order to characterize different influences of left vs right sympathetic lateralization on LV function, haemodynamic effects of right and left stellate ganglion stimulations (RSGS and LSGS) as well as a right sympathetic block (RSB) were compared.
Seven alpha-chloralose anaesthetized open chest dogs were instrumented for measurement of LV pressure (tip manometers) and regional LV wall thickness (WT, sonomicrometry) in the antero-apical wall (AW, innervated by right stellate ganglion) and postero-basal wall (PW, left stellate ganglion). Timing of regional myocadial wall motion was evaluated by the phase of the first Fourier transform of the WT signals, LV asynchrony by the phase difference (phi) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after RSB (5 ml of lidocaine 1%); in 6 dogs of this group, RSGS and LSGS (4 V, 0.2 ms, 20 Hz) were performed before RSB. In order to investigate a regional inotropic stimulation without systemic effect, 6 additional dogs received intracoronary noradrenaline injections (NIC, 0.25 microgram) into the left circumflex artery perfused myocardium.
LSGS and NIC led to an earlier PW-motion within the cardiac cycle (phase reduction by 40.0 +/- 15.0 degree (SEM) and 55.5 +/- 11.2 degrees) and RSGS induced an earlier AW-motion (by 33.7 +/- 15.2 degrees). After RSB, AW-motion was delayed (38.1 +/- 9.2 degrees). The consequence was an asynchronous wall motion pattern after all interventions (change in phi: LSGS-64.7 +/- 18.7 degrees, RSGS 41.1 +/- 15.7 degrees, NIC -74.5 +/- 17.4 degrees, RSB -52.6 +/- 14.6 degrees), and a prolonged relaxation (tau increase: RSGS 9.4 +/- 1.9, NIC 8.3 +/- 1.5, RSB 3.7 +/- 0.8 ms).
Unilateral increases as well as decreases of sympathetic tone to the heart result in an asynchronous wall motion pattern and an impaired LV relaxation.
左心室内不同区域分别由左或右交感神经系统优先供血。为了描述左、右交感神经侧化对左心室功能的不同影响，比较了右和左星状神经节刺激（RSGS和LSGS）以及右交感神经阻滞（RSB）的血流动力学效应。
七只经α-氯醛糖麻醉的开胸犬，通过插入导管测量左心室压力（尖端压力计）和左心室前壁（由右星状神经节支配的前壁，AW）及后壁（由左星状神经节支配的后壁，PW）的局部室壁厚度（WT，超声心动图）。通过WT信号的首次傅里叶变换相位评估局部心肌壁运动的时间，通过两个区域之间的相位差（phi）评估左心室不同步性，通过等容舒张时间常数（tau）评估左心室舒张功能。在RSB（1%利多卡因5ml）前后进行测量；在该组的6只犬中，在RSB之前进行RSGS和LSGS（4V，0.2ms，20Hz）。为了研究无全身效应的局部正性肌力刺激，另外6只犬在左回旋支动脉灌注的心肌内进行冠状动脉内去甲肾上腺素注射（NIC，0.25μg）。
LSGS和NIC导致心动周期内心脏后壁运动提前（相位分别降低40.0±15.0度（标准误）和55.5±11.2度），RSGS导致前壁运动提前（33.7±15.2度）。RSB后，前壁运动延迟（38.1±9.2度）。结果是所有干预后均出现不同步的壁运动模式（phi变化：LSGS为64.7±18.7度，RSGS为41.1±15.7度，NIC为 -74.5±17.4度，RSB为 -52.6±14.6度），以及舒张期延长（tau增加：RSGS为9.4±1.9，NIC为8.3±1.5，RSB为3.7±0.8ms）。
心脏交感神经张力的单侧增加和降低均会导致不同步的壁运动模式和左心室舒张功能受损。
