Effectiveness of Coronary Sinus Retroinfusion on the Acute myocardial Ischemia.

采用同步后灌注系统（SRP）观察地尔硫卓逆行灌注缺血心肌的效果，麻醉杂种狗，阻断左冠状动脉前降支3.5小时。三腔球囊导管经冠状动脉窦置入心脏大静脉。冠状动脉闭塞30分钟后，随机分为4组。A组（n=5）：冠状动脉闭塞维持3小时，未进行任何治疗。B组（n=9）：冠脉闭塞维持3小时，静脉滴注地尔硫卓（3ug/kg/min）。C组（n=8）： SRP开始时静脉滴注地尔硫卓（3ug/kg/min），持续3小时。D组（n=9）： SRP开始时冠脉内静脉滴注地尔硫卓（3ug/kg/min），注入SRP系统体外回路，持续3小时。血流动力学变化，地尔硫卓和英法的血液和心肌浓度，用三苯基特拉唑法估计更多的rct大小，作为危险区域的百分比（用蓝色染料法估计）。结果：地尔硫卓组心率随时间推移明显降低，左室舒张压升高明显抑制（B、C、D组）。两组间左室收缩压、肺动脉压、心输出量差异无统计学意义。将地尔硫卓在静脉血和心肌(心内膜层（End）、缺血(I)和非缺血（N)心外膜层（Epi））中的浓度表出来（平均[]SY.+-. [）S.E., ^ < * * > p < 0.05 v.s. B组):梗塞的大小在D组显著(43.2 (SY。+ -小。(3.1%)较A组(77.5 (SY。+ -。(2.5%)和B (78.9 (SY。+ -。C组(7.6%)(为52.7 (SY。+ -。[)5.9%,n。)。这些数据表明，通过后灌注系统对地尔硫卓进行后灌注，可以将地尔硫卓传递到缺血心肌中，减小最终梗死面积。少

To evaluate the effects of retrograde administration of diltiazem into the ischemic myocardium using synchronized retroperfusion system (SRP), mongrel dogs were anestherized and the left anterior descending coronary artery was occluded for 3.5 hours. A triple lumen balloon tipped catheter for SRP was positioned in the great cardiac vein via the coronary sinus. After 30 minutes of coronary occlusion, dogs were randomly assigned into following 4 groups.Group A (n=5) : Coronary occlusion was maintained for following 3 hours without any treatment.Group B (n=9) : Coronary occlusion was maintained for 3 hours with intravenous infusion of diltiazem (3ug/kg/min).Group C (n=8) : SRP was initiated with intravenous infusion of diltiazem (3ug/kg/min) for 3 hours.Group D (n=9) : SRP was initiated with intracoronary-venous infusion of diltiazem (3ug/kg/min), infused into the extracorporeal circuit of SRP system, for 3 hours.Hemodynamic change, blood and myocardial concentration of diltiazem and infa … More rct sized, estimated by triphenylterazolium method, as a percent of risk area (estimated by blue dye method) were measured.Results : There was significant reduction in heart rate and suppression of the rise of left ventricular enddiastolic pressure with the time of lapse in the groups treated with diltiazem (B,C,D). There were no significant differences between the groups in systolic left ventricular pressure, pulmonary blood pressure and cardiac output. Diltiazem concentrations in the venous blood and the myocardium ( endocardial layr (End), epicardial layr (Epi) in the ischemic (I) and non-ischemic (N)) were tabulated (mean(〕SY.+-.〔)S.E., ^<**>p<0.05 v.s. group B) :The infarcted size in the group D was significantly smaller (43.2(〕SY.+-.〔)3.1%) compared with the group A(77.5(〕SY.+-.〔)2.5%) and B (78.9(〕SY.+-.〔)7.6%)(group C was 52.7(〕SY.+-.〔)5.9%, n.s.). These data indicate that retroinfusion of diltiazem using retroperfusion system can deliver diltiazem into the ischemic myocardium and reduce ultimate infarct size. Less