Kern K B, de la Guardia B, Ewy G A
Department of Medicine, University of Arizona College of Medicine, Tucson 85724, USA.
Resuscitation. 1998 Aug;38(2):107-11. doi: 10.1016/s0300-9572(98)00089-6.
Myocardial blood flow under normal physiologic conditions remains relatively unaltered by coronary lesions with diameter stenosis of less than 70%. However, during cardiac arrest and cardiopulmonary resuscitation (CPR), autoregulation of coronary blood flow is compromised. We studied the effect of previously considered 'trivial' coronary stenoses of 10, 25 and 50% on distal myocardial perfusion in 39 swine undergoing CPR for cardiac arrest. Endocardial blood flow distal to the stenosis was significantly less than that proximal in all the different stenoses groups (P < 0.05). A 50% diameter stenosis also compromised epicardial blood flow distal to the stenosis (P < 0.05). This study suggests that any coronary lesion may compromise myocardial perfusion during CPR. Since the vast majority of cardiac arrest victims have coronary artery disease, careful attention to maximizing myocardial blood flow during CPR is needed.
在正常生理条件下，直径狭窄小于70%的冠状动脉病变对心肌血流的影响相对较小。然而，在心脏骤停和心肺复苏（CPR）期间，冠状动脉血流的自动调节功能受损。我们研究了先前认为“轻微”的10%、25%和50%的冠状动脉狭窄对39只因心脏骤停接受心肺复苏的猪远端心肌灌注的影响。在所有不同狭窄组中，狭窄远端的心内膜血流明显低于近端（P < 0.05）。50%的直径狭窄也会损害狭窄远端的心外膜血流（P < 0.05）。这项研究表明，任何冠状动脉病变都可能在心肺复苏期间损害心肌灌注。由于绝大多数心脏骤停患者患有冠状动脉疾病，因此在心肺复苏期间需要特别注意最大限度地增加心肌血流。
