Percutaneous cooling of ischemic myocardium by hypothermic retroperfusion of autologous arterial blood: effects on regional myocardial temperature distribution and infarct size.
Percutaneous cooling of ischemic myocardium by hypothermic retroperfusion of autologous arterial blood: effects on regional myocardial temperature distribution and infarct size.
复制标题
自体动脉血低温逆灌注经皮冷却缺血心肌：对局部心肌温度分布和梗塞面积的影响。
DOI：
10.1016/s0735-1097(10)80251-7
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发表时间：
1991
影响因子：
24
通讯作者：
Corday,E
中科院分区：
文献类型：
--
作者：
Wakida,Y;Haendchen,RV;Kobayashi,S;Nordlander,R;Corday,E
在开胸犬冠状动脉左前降支闭塞3.5h后，研究了经冠状静脉同步逆灌注冷却自体动脉血对局部心肌温度分布和梗死面积的影响。闭塞30 min后，将犬随机分为三组：1）未处理对照组（n = 5），2）常温逆向灌注组（输注温度32°C）（n = 7）和3）低温逆向灌注组（输注温度15°C）（n = 7）。通过使用针尖热敏电阻在1）闭塞部位远端的前壁，2）闭塞部位近端的前壁，3）左侧壁，4）后壁和5）右心室游离壁中刺入来测量局部心肌温度。还测量了直肠和肺动脉温度。在低温逆向灌注组中，在逆向灌注15分钟时，前壁温度迅速下降5°C（与常温逆向灌注或未处理对照组相比，p < 0.05），而其他部位的温度随时间呈线性趋势下降。在低温逆灌流的前60 min内，缺血区（前壁远端）的心肌温度普遍低于其他部位，逆灌流后15 min时心肌内温差最大（3.6°C）。在低温逆灌注组中，以危险区百分比表示的CT大小明显较小（6.2 ± 3.3%）（64.9 ± 14%）或常温逆灌注组（24.1 ± 6.7%），表明低温逆行灌注可使急性缺血心肌快速降温，心肌内温度梯度小，与常温反向灌注相比，提供更好的心肌保护免受缺血性损伤。
The effects of synchronized coronary venous retroperfusion of cooled autologous arterial blood on regional myocardial temperature distribution and infarct size were studied in open chest dogs with 3.5 h of left anterior descending coronary artery occlusion. After 30 min of occlusion, the dogs were randomly assigned to one of three groups: 1) untreated control group (n = 5), 2) normo-thermic retroperfusion group (infusion temperature 32°C) (n = 7), and 3) hypothermic retroperfusion group (infusion temperature 15°C) (n = 7). Regional myocardial temperatures were measured by using needle-tipped thermistors stabbed in the 1) anterior wall distal to the occlusion site, 2) anterior wall proximal to the occlusion site, 3) left lateral wall, 4) posterior wall, and 5) right ventricular free wall. Rectal and pulmonary artery temperatures were also measured. In the hypothermic retroperfusion group, the anterior wall temperature decreased rapidly by 5°C at 15 min of retroperfusion (p < 0.05 vs. normothermic retroperfusion or untreated control groups), whereas the temperature at other sites decreased with a linear trend over time. Myocardial temperatures in the ischemic area (distal anterior wall) were generally lower than those in the other sites during the first 60 min of hypothermic retroperfusion and the largest intramyocardial temperature difference (3.6°C) was found at 15 min after retroperfusion. Infarct size expressed as a percent of the risk area was significantly smaller in the hypothermic retroperfusion group (6.2 ± 3.3%) than in the control (64.9 ± 14%) or normothermic retroperfusion groups (24.1 ± 6.7%).These results indicate that hypothermic retroperfusion provides rapid regional cooling of acutely ischemic myocardium with small intramyocardial temperature gradients, affording better myocardial protection from ischemic damage compared with normothermic retroperfusion.