Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.
Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.
复制标题
离子和非离子造影剂在正常和缺血状态下的局部心肌血流动力学和代谢影响。
DOI：
10.1161/01.cir.65.7.1307
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发表时间：
1982
期刊：
影响因子：
37.8
通讯作者：
Koziol,JA
中科院分区：
文献类型：
--
作者：
Gerber,KH;Higgins,CB;Yuh,YS;Koziol,JA
在14只麻醉犬冠状动脉内注射两种非离子型造影剂（碘海醇和甲泛葡胺）对心肌收缩和冠状静脉窦（CS）血化学成分的影响，与冠状动脉造影标准离子型造影剂泛影葡胺钠（R76）的影响进行了比较。在正常状态和存在临界冠状动脉狭窄的情况下，比较每种药物对局部收缩力的影响。三种造影剂产生的红细胞压积和钠（均为NS）降低相当，但R76导致CS渗透压摩尔浓度增加更大（p <0.02）。R76导致CS钾和离子钙显著降低（均p <0.001），但两种非离子造影剂均未导致钾或钙的显著变化。在正常状态下，R76引起舒张末期（p <0.006）和收缩末期（p <0.02）节段长度的初始一过性（小于10秒）增加以及节段长度变化率（dL/dt）的降低（p <0.002）。非离子型药物导致dL/dt轻度增加（p <0.04）和收缩末期节段长度减少（p <0.03）;两者均在1分钟内恢复至对照水平。在存在狭窄的情况下，R76导致舒张末期和收缩末期节段长度更严重和更长时间的增加（p <0.03）和dL/dt降低（p <0.002），在2分钟内未恢复到控制水平。在正常和患病状态下，非离子剂的作用相似。我们的结论是，非离子型造影剂比离子型造影剂在冠状窦血液化学和心肌收缩状态方面产生更少的改变。在冠状动脉狭窄的情况下，离子型造影剂对局部收缩的影响更明显。
The effects of intracoronary injection of two nonionic contrast media (iohexol and metrizamide) on myocardial contraction and chemical composition of coronary sinus (CS) blood were compared with those caused by the standard ionic contrast material for coronary angiography, sodium meglumine diatrizoate (R76), in 14 anesthetized dogs. The effects of each agent on regional contractility were compared in the normal state and in the presence of a critical coronary artery stenosis. The three contrast media produced equivalent decreases in hematocrit and sodium (both NS), but R76 caused a greater increase in CS osmolality (p less than 0.02). R76 caused a significant decrease in CS potassium and ionized calcium (both p less than 0.001), but neither nonionic contrast medium caused a significant change in either potassium or calcium. In the normal state, R76 caused initial transient (less than 10 seconds) increases in both end-diastolic (p less than 0.006) and end-systolic segment length (p less than 0.02) and a decrease in rate of change of segment length (dL/dt) (p less than 0.002). The nonionic agents caused a mild increase in dL/dt (p less than 0.04) and a decrease in end-systolic segment length (p less than 0.03); both returned to control levels within 1 minute. In the presence of a stenosis, R76 caused a more severe and prolonged increase in end-diastolic and end-systolic segment lengths (p less than 0.03) and a decrease in dL/dt (p less than 0.002), which did not return to control within 2 minutes. The effects of the nonionic agents were similar in both normal and diseased states. We conclude that nonionic contrast media produce fewer alterations than ionic contrast media in coronary sinus blood chemistry and myocardial contractile state. The effect of ionic contrast media on regional contraction is accentuated in the presence of coronary artery stenosis.