离体灌注大鼠辅助心脏控制序贯起搏。

European journal of cardiology Pub Date : 1979-09-01
O C Penn, S T Boyd, J B Korrûbel, L H Opie, C N Barnard
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摘要

临床辅助心脏移植后的一个重要问题是是否需要控制双心起搏以保护患病的受者心脏。在离体双鼠灌注工作心脏中,比较了三种起搏方式(随机、同步和顺序)对自发搏动的影响。这两颗心脏通过心房连接在一起,与临床情况类似。在控制序贯起搏时,两颗正常心脏的峰值收缩压下降,舒张压上升,但总心输出量没有变化。同期起搏时收缩压升高,舒张压下降,冠状动脉血流较序贯起搏时减少,但摄氧量较高。因此,当左主干冠状动脉结扎导致其中一个心脏功能下降时,序贯起搏的效果可能是有益的。序贯起搏时心输出量由10 ~ 30 ml/min显著提高(P < 0.001),冠状动脉血流增加。心肌耗氧量由80微升/g/min升高至110微升/g/min (P < 0.05)。因此,序贯起搏可以改善辅助心脏存在时冠状结扎心脏严重压抑的血流动力学。心肌耗氧量增加被认为是舒张期灌注压增加的有益影响,与酶释放增加无关。结论:序贯起搏在临床辅助心脏移植中的作用值得评价。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Controlled sequential pacing in isolated perfused auxiliary rat hearts.

An important question after clinical auxiliary heart transplantation is whether controlled pacing of both hearts is desirable in order to protect the diseased recipient heart. A comparison of the effects of spontaneous beating with three types of pacing (random, simultaneous and sequential) was undertaken in an isolated perfused working double rat heart. The two hearts were attached to each other by the atria, in a way comparable to the clinical situation. During controlled sequential pacing of both normal hearts, the peak systolic pressure fell and diastolic pressure rose, but the combined cardiac output did not changes. In contrast, during simultaneous pacing, systolic pressure rose, diastolic pressure fell and coronary flow was less than with sequential pacing, but the oxygen uptake was higher. Hence the effects of sequential pacing could be expected to be beneficial when function of one of the hearts was depressed by left main coronary artery ligation. During sequential pacing the cardiac output was significantly improved from 10 to 30 ml/min (P less than 0.001) and coronary flow rose. Myocardial oxygen consumption increased from 80 to 110 microliters/g/min (P less than 0.05). Thus sequential pacing could improve the severely depressed hemodynamics of the coronary-ligated heart in the presence of an auxiliary heart. The increased myocardial oxygen consumption is viewed as a beneficial effect of increased diastolic perfusion pressure and was not associated with increased enzyme release. It is concluded that the effects of sequential pacing warrant assessment in clinical auxiliary heart transplantation.

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