Characterization of the cardiac effects of acute subarachnoid hemorrhage in dogs
Characterization of the cardiac effects of acute subarachnoid hemorrhage in dogs
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DOI：
10.1161/01.str.27.4.737
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发表时间：
1996-04-01
期刊：
影响因子：
8.3
通讯作者：
Brillman, J
中科院分区：
文献类型：
--
作者：
Elrifai, AM;Bailes, JE;Brillman, J
背景和目的我们知道急性颅内出血患者，特别是蛛网膜下腔出血患者可发生明显的心脏受损伤。这些患者可能表现出以前认为是良性的心电图异常。然而，许多人死于心血管后遗症，这表明更严重的心脏问题。为了描述蛛网膜下腔出血后2 ~ 4小时发生的心脏、节律和心肌紊乱，我们进行了一项实验研究，将自体血液（7.9+/-0.3 mL）注射到犬的右额叶和蛛网膜下腔。方法用异氟醚麻醉9只成年杂种犬，保持其直肠温度在37℃，连续测定其心电图、心率、平均动脉压、平均肺动脉压和颅内压。在颅内出血前、出血后立即、出血后2、4小时行经食管超声心动图评价心肌壁运动变化及主动脉、肺血流速度。采集血液样本，分析儿茶酚胺和心脏酶，并测量心输出量。蛛网膜下腔出血后2 ~ 4小时处死动物，冰冻夹持一块心肌，分析组织儿茶酚胺。采用光镜和电镜进行组织病理学检查。结果蛛网膜下腔出血导致颅内压、心排血量、主动脉和肺血流速度显著升高。肌酸激酶和儿茶酚胺也有显著变化。4只动物在注射后1 ~ 5分钟出现心动过速、st段压低、倒T波、室性早搏变化，20 ~ 240分钟超声心动图均有明显变化。用光学显微镜对一只动物的心脏进行了显微镜检查，用电子显微镜对九只动物的心脏进行了显微镜检查。结论：本研究表明，蛛网膜下腔出血后发生的心脏受累，特别是壁运动异常的发生率很高，并提示对这些患者进行持续心脏监测，特别是超声心动图测量的重要性。
Background and Purpose We know that significant cardiac involvement can occur in patients with acute intracranial hemorrhage, particularly in those with subarachnoid hemorrhage. These patients may present with electrocardiographic abnormalities that were previously thought to be benign. However, many die of cardiovascular sequelae, which suggests more serious cardiac problems. To characterize the cardiac, rhythmic, and myocardial disturbances that occur 2 to 4 hours after subarachnoid hemorrhage, we conducted an experimental study using autologous blood (7.9+/-0.3 mL) injected into the right frontal lobe and subarachnoid space in canines.Methods Nine adult mongrel dogs were anesthetized with isoflurane and their rectal temperatures maintained at 37 degrees C. Electrocardiogram, heart rate, mean arterial pressure, mean pulmonary artery pressure, and intracranial pressure were continuously measured. Transesophageal echocardiography was performed to assess myocardial wall motion changes and aortic and pulmonary flow velocities before, immediately after, and 2 and 4 hours after intracranial hemorrhage. Blood samples were collected and analyzed for catecholamines and cardiac enzymes, and cardiac output was measured. Animals were killed at 2 to 4 hours after subarachnoid hemorrhage, and a piece of the myocardium was freeze-clamped for analysis of tissue catecholamines. Light and electron microscopy were used for histopathologic assessment.Results Subarachnoid hemorrhage produced significant increases in intracranial pressure, cardiac output, and aortic and pulmonary flow velocities. Also, significant changes in creatine kinase and catecholamines were observed. Electrocardiographic recordings showed changes of tachycardia, ST-segment depression, inverted T wave, and premature ventricular contractions in four animals at 1 to 5 minutes after injection, and echocardiographic changes were evident in all animals at 20 to 240 minutes. Microscopic examination of the heart showed evidence of myocardial changes in one animal with the use of light microscopy and in nine with the use of electron microscopy.Conclusions This study demonstrates the high incidence of cardiac involvement, specifically wall motion abnormalities, that occur after subarachnoid hemorrhage and suggests the importance of continuous cardiac monitoring, particularly echocardiographic measurements, in those patients.