Hemodynamics and Endothelial Function of Perioperative Myocardial Ischemia

为了确定副映射神经可以引发coroanry constriction的刺激，我们做了两项研究，包括狗中的内乙酰胆碱素压力测试和患者中的肾上腺素压力测试. 1）动物实验：研究可能调制的冠状血管音调内乙酰胆碱素（Ach）注射的反应。方法： 6个成功的实验是在10只狗中完成的。狗用三氟醚（5毫克/千克）和吗啡（3毫克/千克）对狗进行了消毒，并用七氟醚的抑制剂进行了保养。从Carotid Artery到LAD的Coronary Shunt已安装。电磁波流量探测器被插入和测量到LAD. HR是由完成后的AV块（123 bpm）控制的。血液压力维护与压力血液储备（84 mmHg）。通过这个大峡谷注射的内部Acs分级（0.01- 1 Omicrog）。LAD流动与冠状灌注率有关 ... More 很明显，它被监视在攻击性注射器后面。内皮素t（ET-1）被浪费到从基线值减少了30%的共同线性流量。在ET-1的融合之前和之后，压力测试重复发生。结果： LAD流动增加了一个内部Ace Indose Dependent。manaer. ET-1对Ach的抑制性LAD流响应。LAD流在恢复后反应性hyperemia与ET-1发生反应后减少了对照值，但没有ET-1。结论：Highcoronary vascular tone possibly need to induce the coronary constriction with the activation of parasympathetic nerve. 2）Clinical study ： To study whether the activation of parasympathetic nerve induce myocardial ischemia due to the coronary spasm。材料和方法：我们研究了15名患者与冠状动脉疾病进行选择性冠状动脉外科（CABG）。一大笔Edr剂量（0.25毫克·千克-1）是通过左内部多层动脉吸收的中央有效凯瑟琳。Edr成功地在所有患者中接受了Sinus Bradycardia。心率（HR）在3分钟内达到最大降幅（-15.3*6.8节拍·min-1， p<O.O1）。人力资源的最大减少被分配到增加基线人力资源（r=-0.80， p<O.001）。系统性和脉冲性气象压力在此期间没有发生变化。在注射后1分钟内出现PQ持续时间的延长（p<O.01）。ST段没有新的设置在20分钟的前导II或V5上。结论：只有在患有异化学心脏病的患者中，准性神经缺乏可能性的自发性高潮的激活。Less（低）

To determine whether the stimulation of parasymapthetic nerve could evoke the coroanry constriction, we conducted two studies including the intracoronary acetylcholine stress test in dogs and the edrohpnium stress test in patients with ischemic heart disease.1)Animal experiment : To investigate that the coronary vascular tone possibly modulate the response of intracoronary acethylcholine (Ach) injection. Methods : 6 successful experiments were accomplished in 10 dogs. Dogs were anesthetized with thiopental (5mg/kg) and morphine (3mg/kg) and maintained with inhalation of sevoflurane. Coronary shunt from carotid artery to LAD was installed. EM flow probe was incorporated and measured the toal coronary flow to LAD.HR was controlled by ventricula pacing after the accomplishion fo AV block (123 bpm). Blood pressure maintaine with the pressurized blood reservor (84mmHg). The graded doses of intracoronary Ach (0.01-1Omicrog) injected through this cannula. LAD flow arid coronary perfusion pres … More sure were monitored following the Ach injection. Intracoronary endotheline-t (ET-1) was infused to redue 30% of co ronary flow fromthe baseline value. Ach stress test was repeated before and after introcoronary in fusion of ET-1. Results : LAD flow increased with intracoronary Ach indose dependent. mannaer.ET-1 inhibited LAD flow response to Ach. LAD flow decreased below contorl value at the recoveryphase after reactive hyperemia to Ach with ET-1, but not without ET-1. Conclusion : High coronary vascular tone possibly need to induce the coronary constriction with the activation of parasympathetic nerve.2)Clinical study : To study whether the activation of parasympathetic nerve induce myocardial ischemia due to the coronary spasm. Material and methods : We studied 15 patients with coronary artery disease scheduled for elective coronary artery surgery (CABG). A bolus dose of Edr (0.25mg・kg-1) was injected through a central venous catheterl during harvesting of left internal thoracic artery. Edr successfully induced sinus bradycardia in all patients. Heart rate (HR) reached the maximum reduction at 3 minutes (-15.3*6.8 beat・smin-1, p<O.O1). The maximum reduction of HR was proportionally amplified with an increasing baseline HR (r=-0.80, p<O.001). Systemic and pulmonary arterial pressures did not change during this period. Prolongation of PQ duration appeared on lead II EGG for 1 minute after Edr injection (p<O.0 1). No new deviation of ST segments was observed on leads II or V5 for 20 minutes. Conclusion : Only the activation of parasympathetic nerve less possibly induce coronary spasm in the patients with ischemic heart disease. Less