Response to myocardial ischemia as a regulated process.
Response to myocardial ischemia as a regulated process.
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对心肌缺血的反应是一个调节过程。
DOI：
10.1161/01.cir.84.6.2580
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发表时间：
1991
期刊：
影响因子：
37.8
通讯作者：
Pantely,GA
中科院分区：
文献类型：
--
作者：
Bristow,JD;Arai,AE;Anselone,CG;Pantely,GA
在很大程度上，我们对心肌缺血的病理生理学的认识是基于冠状动脉完全闭塞，心肌血流几乎完全停止。从血液动力学、代谢、结构和治疗的角度详细研究了由此产生的事件序列。对心肌坏死或完全闭塞缓解后恢复过程的研究对于指导冠状动脉血栓形成和急性心肌梗死的新方法至关重要。然而，这种损伤的严重程度不允许评估心脏中一些重要的调节过程，特别是当考虑慢性冠状动脉狭窄和”冬眠心肌”时。本文综述了心肌血流量、机械功能和高能磷酸盐代谢与冠状动脉血流量轻度至中度减少之间的关系。人们已经深入了解了心脏对动脉灌注减少的挑战的反应方式，并遇到了一些惊喜。缺血时的观察结果包括冠状动脉阻力血管的不完全扩张、收缩储备和代谢调节。对这些现象的更全面的理解可能最终有助于解释缺血期间心肌功能的明显下调。可以得出这样的结论：心脏对中度严重缺血的反应是受控的和有目的的，有助于心肌的存活。
T oa great extent, our knowledge of the pathophysiology of myocardial ischemia is based on complete coronary arterial occlusion, with almost total cessation of myocardial blood flow. The resulting sequence of events has been studied in detail, from hemodynamic, metabolic, structural, and therapeutic standpoints. Investigations of the evolution of the process to myocardial necrosis or to recovery after relief of the total occlusion have been essential in guiding new approaches to the management of coronary thrombosis and acute myocardial infarction. However, the severity of that insult does not allow evaluation of some important regulatory processes in the heart that are of interest, especially when chronic coronary stenosis and the" hibernating myocardium" are considered. This review outlines the relations among myocardial blood flow, mechanical function, and high-energy phosphate metabolism with mild-to-moderate reductions in coronary blood flow. Insights have been gained into the ways in which the heart responds to the challenge of decreased arterial perfusion, and some surprises have been encountered. Observations during ischemia include incomplete dilation of coro-nary resistance vessels, contractile reserve, and metabolic adjustments. A more complete understanding of these phenomena may ultimately help to explain the apparent downregulation of myocardial function during ischemia. The conclusion can be reached that the heart's response to moderately severe ischemia is controlled and purposeful, contributing to survival of the myocardium.