Effectiveness of Coronary Sinus Retroinfusion on the Acute myocardial Ischemia.

为探讨同步逆向灌注系统（SRP）逆行灌注地尔硫（Diltiazem）对缺血心肌的保护作用，将杂种犬麻醉后，结扎冠状动脉左前降支3.5小时。通过冠状窦将用于SRP的三腔球囊头端导管定位在心大静脉中。冠状动脉闭塞30分钟后，将犬随机分为以下4组：A组（n=5）：维持冠状动脉闭塞3小时，不进行任何治疗; B组（n=9）：静脉滴注地尔硫卓维持冠状动脉闭塞3小时C组（n=8）：静脉滴注地尔硫卓（diltiazem），开始实施SRP D组（n=9）：经冠状动脉静脉输注地尔硫卓启动SRP（3 ug/kg/min），输注至SRP系统的体外回路中，持续3小时。血流动力学变化、地尔硫卓和infa的血液和心肌浓度 关于我们 结果：地尔硫卓（B、C、D）治疗组随着时间的延长，心率明显减慢，左室舒张末压升高明显抑制，与对照组比较差异有显著性（P <0.05）。两组间左室收缩压、肺动脉压和心输出量无显著差异。将静脉血和心肌（缺血（I）和非缺血（N）的心内膜层（End）、心外膜层（Epi））中的地尔硫卓浓度制成表格（平均值（）SY ±。（）S.E.，^<**>p<0.05 vs. B组：D组梗死面积明显小于D组（43.2 ± 0.05）SY. ()3.1与A组（77.5% ± 0.5%）比较，P < 0.05。()2.5%）和B（78.9（±）SY. ()7.6 C组为52.7SY ± 0.5SY。()5.9%，n.s.）。这些数据表明，使用逆灌注系统逆输注地尔硫卓可以将地尔硫卓输送到缺血心肌中，并减少最终的梗死面积。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