The Time Course and Characterization of Myocardial Hemorrhage After Coronary Reperfusion in the Anesthetized Dog
The Time Course and Characterization of Myocardial Hemorrhage After Coronary Reperfusion in the Anesthetized Dog
复制标题
麻醉犬冠状动脉再灌注后心肌出血的时程及特征
作者：
L. Higginson;D. Beanlands;Vera Temple;K. Sheldrick
我们对不同时间的心肌缺血后再灌注相关的出血进行了定量，并检查了伴随再灌注出血的血流特征。麻醉犬在旋支闭塞2、6或24小时后再灌注。对照组行冠状动脉闭塞术，不进行再灌注。分别于再灌注前、再灌注后5 min和24 h注射放射性微球。分析乳头肌的血红蛋白含量、心肌缺血期间的流量以及再灌注早期和24小时后的流量。测定心肌肌酸激酶活性，以确定乳头肌心肌坏死的严重程度。出血进入后乳头肌取决于冠状动脉闭塞的持续时间。后乳头血红蛋白在闭塞后2小时组平均为14 mg/g，6小时组为28 mg/g，24小时再灌注组为36 mg/g，而对照组为8.7 mg/g。侧支流动）。2小时组的早期复流平均为112 ml/min/100 g，6小时组为61 ml/min/100 g，24小时组仅为5.8 ml/min/100 g。因此，急性缺血心肌再灌注引起的心肌出血与闭塞期间的严重缺血和严重心肌坏死有关，但不依赖于早期复流的程度。即使初始复流值显著降低，也可能发生心肌出血。
We quantitated hemorrhage associated with reperfusion after varying periods of myocardial ischemia and examined the flow characteristics that accompany reperfusion hemorrhage. Anesthetized dogs were reperfused after 2, 6 or 24 hours of circumflex occlusion. A control group underwent coronary occlusion without reperfusion. Radioactive microspheres were injected before and 5 minutes and 24 hours after reperfusion. The papillary muscles were analyzed for hemoglobin content, flow during myocardial ischemia and flow early and 24 hours after reperfusion. Myocardial creatine kinase activity was assayed to determine the severity of myocardial necrosis in the papillary muscles. Hemorrhage into the posterior papillary muscle was dependent upon the duration of coronary artery occlusion. Posterior papillary hemoglobin averaged 14 mglg in the 2-hour group, 28 mg/g in the 6-hour group and 36 mg/g in the group reperfused 24 hours after occlusion, compared with 8.7 mg/g in the control group.Myocardial hemorrhage was associated with severe depression in myocardial CK and marked depression in flow to the ischemic area (i.e., collateral flow) during the occlusion. Early reflow averaged 112 ml/min/100 g in the 2-hour group, 61 ml/min/100 g in the 6-hour group and only 5.8 ml/min/lO0 g in the 24- hour group. Therefore, myocardial hemorrhage induced by reperfusion of the acutel ischemic myocardium is associated with severe ischemia during occlusion and severe myocardial necrosis, but does not depend upon the magnitude of early reflow. Myocardial hemorrhage may occur even though initial reflow values are markedly decreased.