Metabolic and functional effects of perfluorocarbon distal perfusion during coronary angioplasty.
Metabolic and functional effects of perfluorocarbon distal perfusion during coronary angioplasty.
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DOI：
10.1016/0002-9149(90)91001-m
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发表时间：
1990-04
期刊：
影响因子：
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通讯作者：
L. Young;C. Jaffe;J. Revkin;P. McNulty;M. Cleman
中科院分区：
文献类型：
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作者：
L. Young;C. Jaffe;J. Revkin;P. McNulty;M. Cleman
对12例冠状动脉左前降支冠脉成形术患者在冠脉远端灌注(氧合和非充氧)和常规方法不行冠脉远端灌注的同时，对心肌乳酸代谢和左心功能进行了研究。球囊充气前心脏乳酸净摄取率为(31±6)%。在远端灌流的球囊充气期间，当球囊充气时，乳酸盐净释放到心脏大静脉；充氧时心脏大静脉乳酸浓度比非充氧氟化吸入时低约25%(p<；0.02)，这表明心肌乳酸释放较少。在气囊放气后，3种方案都观察到乳酸被洗出到心脏大静脉(心肌净释放)。超声心动图测得的左心室射血分数在充气时显著降低(53±3%至36±3%，p<；0.001)和无氧氟舒张时(52±2至30±3%，p<；0.001)。充氧氟化吸入可在很大程度上预防这种功能障碍，其射血分数仅有轻微下降(51±2vs48±2%，p<；0.02)。对局部收缩功能的分析也得出了类似的结果。尽管含氧全氟碳化合物减少了血管成形术中心脏乳酸的释放，但这项研究提供了证据，证明即使在心功能保留的情况下，乳酸的产生也是开始的。
Myocardial lactate metabolism and left ventricular function were studied in 12 patients during angioplasty of the left anterior descending artery performed with distal coronary perfusion (oxygenated and nonoxygenated FluosolTM) and by conventional technique without distal perfusion. Before balloon inflation there was net lactate extraction by the heart (31 ± 6%). During balloon inflations performed with distal perfusion there was net lactate release into the great cardiac vein while the balloon was inflated; the great cardiac vein lactate concentration was approximately 25% lower during perfusion with oxygenated versus nonoxygenated Fluosol (p < 0.02) indicating less myocardial lactate release. After balloon deflation washout of lactate into the great cardiac vein (net myocardial release) was observed in all 3 protocols. Left ventricular ejection fraction measured by echocardiography decreased markedly during nonperfused (53 ± 3 to 36 ± 3%, p < 0.001) and nonoxygenated Fluosol (52 ± 2 to 30 ± 3%, p < 0.001) inflations. This dysfunction was largely prevented by oxygenated Fluosol where only a minimal decrease in ejection fraction (51 ± 2 vs 48 ± 2%, p < 0.02) occurred. Analysis of regional contractile function yielded similar results. Although oxygenated perfluorocarbons decrease cardiac lactate release during angioplasty, this study provides evidence for the onset of lactate production even when ventricular function is preserved.