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目的 观察局部心肌顿抑对全身血液动力学及心肌氧供需平衡的影响。方法 杂种犬33条 ,常温下冠状动脉左前降支根部阻断 15min ,观察再灌注后全身血液动力学、冠脉流量及缺血心肌氧供氧耗的变化。结果 MAP在冠脉阻断期间稍下降 ,再灌注后升至基础水平 ;HR在缺血 /再灌注过程中均明显增快 ;冠脉阻断后 ,CO、SV、左室收缩功指数均迅疾下降 ,再灌注 5min略有升高 ,之后进行性下降 ;再灌注后 ,体循环血管阻力、肺血管阻力均呈进行性增高 ;再灌注 5min冠脉流量、心肌氧供、氧耗均显著升高 ,然后同步下降 ;心肌氧摄取率在缺血 /再灌注过程中无明显变化。电镜检查 :再灌注 30min ,心肌纤维肿胀 ,间质明显水肿 ,毛细血管淤血 ,线粒体大量空泡 ;结论 局部心肌顿抑可引起明显的血液动力学变化 ;再灌注初期存在明显的氧耗反常 ,而再灌注后期心肌氧供、氧耗基本相配。
Objective To observe the effect of local myocardial stunning on systemic hemodynamics and myocardial oxygen supply and demand balance. Methods 33 dogs were anesthetized, and the left anterior descending coronary artery was blocked for 15 minutes at room temperature. The changes of hemodynamics, coronary flow and the oxygen consumption of ischemic myocardium were observed after reperfusion. Results During the period of coronary artery occlusion, MAP decreased slightly and reached the basal level after reperfusion. HR was significantly increased during ischemia / reperfusion. After coronary occlusion, the index of CO, SV and LV systolic function were both fast Decreased slightly and reperfusion 5min increased slightly, and then decreased; After reperfusion, systemic vascular resistance, pulmonary vascular resistance were increased; reperfusion 5min coronary flow, myocardial oxygen supply, oxygen consumption were significantly increased, Then decreased synchronously; myocardial oxygen uptake rate had no significant change during ischemia / reperfusion. Electron microscopy: reperfusion 30min, myocardial fibrosis, interstitial edema, capillary congestion, a large number of vacuoles mitochondria; Conclusion Local myocardial stunning can cause significant hemodynamic changes; early reperfusion there is a significant oxygen consumption anomalies, and Late reperfusion myocardial oxygen supply, oxygen consumption basically match.