AUTONOMIC NERVE ACTIVITY AND PLATELET ACTIVATION RELATED TO THE PERIOPERATIVE CORONARY SPASM IN THE PATIENTS WITH ISCHEMIC HEART DISEASE

冠状动脉痉挛的病因尚不清楚。因此，本研究探讨围手术期冠状动脉痉挛的发生是否与自主神经活动或血小板活性有关。为此，我们进行了以下工作：1.在移动的PC机上建立了同步记录系统，并对经食管超声心动图、心电图和模拟压力波形的可视化图像进行了感兴趣区域的颗粒和密度分析。2.检查了CPB期间低温是否损害了血管内皮扩张，这可能导致CPB后持续的心肌低灌注。上述结果提示，深低温体外循环中Ach对血管反应的钝化作用比TNG更明显。这表明深低温CPB对内皮功能的损害比对平滑肌功能的损害更严重。3.我们研究了即使是少量的肝素和鱼精蛋白的产生， ...更多信息 通过与体外循环CABG患者比较，发现非体外循环CABG患者的血小板复合物（HPC）对血小板功能有影响。尽管小剂量肝素可激活血小板功能，但小剂量肝素酶和鱼精蛋白可减少HPC的产生，即使在非体外循环CABG中也能抑制血小板功能。4. RR间期分析显示，麻醉诱导期间副交感神经活性增强，但交感神经活性无明显变化。因此，在麻醉诱导过程中诱发冠状动脉痉挛的可能性较小。在气管插管期间，副交感神经活动增加，伴随着交感神经活动的增强。虽然心肌缺血没有检测到任何一种情况下，有可能诱发冠状动脉痉挛气管插管依赖于交感神经和副交感神经激活的平衡，缺血性心脏病患者。除麻醉诱导和麻醉期间气管插管外，还需要进一步研究以确定其他触发冠状动脉痉挛的因素。少

Etiology of coronary spasm is still unknown. Therefore, we investigated whether the autonomic activity or platelet activity related to the occurrence of the coronary spasm during perioperative period. For this purpose, we carried out the following.1.We constructed the simultaneous recording system and the particle and dense analysis in the regional area for interest on visual images of the transesophageal echocardiography, ECGs, and analog pressure wave forms on the mobile PC.2.We examined whether vascular endothelial dilatation was impaired with hypothermia during CPB, which might cause the prolonged hypoperfusion of myocardium after CPB. In conclusion, these results indicated that the blunting of the vascular response to Ach was more prominent than that to TNG in deep hypothermic CPB. This suggests that deep hypothermic CPB caused severe impairment to the endothelial function than to the smooth muscle function.3.We investigated whether even a smaller production of heparin and protami … More n complex(HPC) in patients with off-pump CABG would affect platelet function, by comparing in patients with on-pump CABG. Although a small dose of heparin activated the platelet function, a reduced production of HPC, estimated by smaller doses of hepain and protamin, did inhibit platelet function even in off-pump CABG.4.Parasympathetic activity augmented, but sympathetic activity did not change during anesthesia induction with using RR-inteirval analysis. Therefore, there was less possibility to induce coronary spasm during anesthesia induction. During the tracheal intubation, parasympathetic activity increased with accompanying augmentation of sympathetic activity. Although myocardial ischemia did not detect either situation, there was a possibility to induce the coronary spasm during tracheal intubation dependent on the balance of sympathetic and parasympathetic activation in the patients with ischemic heart disease. Further investigation is necessary for the determination of the other triggering of coronary spasm except anesthesia induction and tracheal intubation during anesthesia. Less