Kleen M, Welte M, Lackermeier P, Habler O, Kemming G, Messmer K
Institute for Surgical Research, University of Munich, 81366 Munich, Germany.
J Appl Physiol (1985). 1997 Dec;83(6):1832-41. doi: 10.1152/jappl.1997.83.6.1832.
Myocardial blood flow heterogeneity in shock and small-volume resuscitation in pigs with coronary stenosis. J. Appl. Physiol. 83(6): 1832-1841, 1997.-We analyzed the effects of shock and small-volume resuscitation in the presence of coronary stenosis on fractal dimension (D) and spatial correlation (SC) of regional myocardial perfusion. Hemorrhagic shock was induced and maintained for 1 h. Pigs were resuscitated with hypertonic saline-dextran 60 [HSDex, 10% of shed blood volume (SBV)] or normal saline (NS; 80% of SBV). Therapy was continued after 30 min with dextran (10% SBV). At baseline, D was 1.39 +/- 0.06 (mean +/- SE; HSDex group) and 1.34 +/- 0.04 (NS group). SC was 0.26 +/- 0.07 (HSDex) and 0.26 +/- 0.04 (NS). Left anterior descending coronary artery stenosis changed neither D nor SC. Shock significantly reduced D (i.e., homogenized perfusion): 1.26 +/- 0.06 (HSDex) and 1.23 +/- 0.05 (NS). SC was increased: 0.41 +/- 0.1 (HSDex) and 0.48 +/- 0.07 (NS). Fluid therapy with HSDex further decreased D to 1.22 +/- 0.05, whereas NS did not change D. SC was increased by both HSDex (0.56 +/- 0.1) and NS (0.53 +/- 0.06). At 1 h after resuscitation, SC was constant in both groups, and D was reduced only in the NS group (1.18 +/- 0.02). We conclude that hemorrhagic shock homogenized regional myocardial perfusion in coronary stenosis and that fluid therapy failed to restore this.
冠状动脉狭窄猪休克及小容量复苏时的心肌血流异质性。《应用生理学杂志》83(6): 1832 - 1841, 1997年。-我们分析了冠状动脉狭窄情况下休克及小容量复苏对局部心肌灌注分形维数（D）和空间相关性（SC）的影响。诱导并维持失血性休克1小时。用高渗盐水 - 右旋糖酐60 [HSDex，失血量（SBV）的10%] 或生理盐水（NS；SBV的80%）对猪进行复苏。30分钟后继续用右旋糖酐（SBV的10%）治疗。基线时，D值在HSDex组为1.39±0.06（均值±标准误），在NS组为1.34±0.04。SC值在HSDex组为0.26±0.07，在NS组为0.26±0.04。左前降支冠状动脉狭窄对D和SC均无影响。休克显著降低D（即灌注均匀化）：在HSDex组为1.26±0.06，在NS组为1.23±0.05。SC增加：在HSDex组为0.41±0.1，在NS组为0.48±0.07。用HSDex进行液体治疗使D进一步降至1.22±0.05，而NS未改变D。HSDex（0.56±0.1）和NS（0.53±0.06）均使SC增加。复苏后1小时，两组的SC均保持稳定，仅NS组的D降低（1.18±0.02）。我们得出结论，失血性休克使冠状动脉狭窄时的局部心肌灌注均匀化，且液体治疗未能恢复这一状态。
