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犬不同冠脉狭窄部位和心肌缺血范围对左室收缩功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2000年第6期
页码:
440-442
栏目:
论著
出版日期:
2000-12-01

文章信息/Info

Title:
Effect of different part of left coronary artery stenosis and myocardial risk areas on left ventricular contractile function in dogs
作者:
周晓东1;  刘翠华4;  朱妙章2;  钱蕴秋1;  郜发宝3;  臧益民2
第四军医大学: 1. 西京医院超声诊断科, 2. 生理学教研室,3. 西京医院放射科, 陕西西安710032; 4. 武警陕西总队特诊科
Author(s):
ZHOU Xiao-dong1;  LIU Cui-hua4;  ZHU Miao-zhang2;  QIAN Yun-qiu1;  GAO Fa-bao 3;  ZANG Yi min2
Ultrasound Department of Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi 710032, China
关键词:
心脏功能;  超声心动描记术;  冠状动脉疾病
Keywords:
cardiac function;  echocardiography;  coronary disease
分类号:
R445.1
DOI:
-
文献标识码:
A
摘要:
目的 观察犬不同冠脉狭窄部位和心肌缺血范围对左室收缩功能的影响。方法 2 0只杂种犬 ,静脉注射苯巴比妥钠常规麻醉。左侧开胸 ,分离心包并做一心包吊床。微米缩窄器和电磁流量计探头分别环绕放置在左前降支(L AD)和左旋支 (L CX)的不同部位 ,造成冠脉重度狭窄 (冠脉血流量 CBF减少 70 %～ 80 % )。采用二维超声心动图定量观察心肌缺血的范围。10只犬在静息情况下 ,采用选择性冠脉造影 ,观察心肌缺血区 ,并与相应冠脉供血区作对比研究。结果 严重冠脉狭窄后室壁运动异常的圆周范围 (CEWMA)百分比在各短轴切面分布不同。在心底 (二尖瓣口 )切面 :L CX阻塞时 CEWMA占切面圆周的 (5 8± 8) % ,L AD阻塞时 CEWMA占 (18± 6)% ;而在心尖平面 :L CX阻塞时 CEWMA占 (36± 6 ) % ,L AD阻塞时 CEWMA占 (5 5± 9) %。L CX近端或两支冠脉狭窄时才出现主动脉最大血流速度 (APV )、射血分数 (EF)和心输出量 (CO)明显减低。单平面观测 ,CEWMA超过 5 5 %时才出现 EF,APV的改变 ,特别是在侧壁节段异常时。结论 心肌缺血范围与左心收缩功能呈正相关。二维超声心动图是定量检测冠心病左心收缩功能的简便、无创的技术。
Abstract:
AIM We sought to determine the effect of different part of coronary artery stenosis and myocardial risk areas on left ventricular contractile function in dogs by two dimensional echocardiography (2DE). METHODS 20 mongrel dogs were placed under general anesthesia with intravenous sodium pentobarbital, intubated and placed on a respirator. A left lateral thoracotomy was performed and the heart was suspended in a pericardial cradle. A micrometer constrictor and electromagnetic flow meter were placed around the different part of the left descending coronary artery (LAD) and left circumflex coronary artery (LCX) to produce severe coronary artery stenosis and myocardial ischemia (70%～ 80% reduction was observed in coronary blood flow). In 10 dogs, a selective injection of coronary artery with contrast agent were given at rest in order to measure the contrast enhance area and compare with the myocardial risk area and the supplied region of left coronary artery. RESULTS In severe stenosis, the circumference extent of wall motion abnormality (CEWMA ) is (18±6)% in LAD and (58±8)% in LCX at the mitral valve orifice short axis plane; CEWMA is (55±9)% in LAD and (36±6)% in LCX at the short-axis apex level. The aortic peak velocity (APV), ejection fraction (EF) and cardiac output (CO) was significantly lower when proximal LXC or tow-vessel stenosis was present. APV and EF was significantly lower when CEWMA over 55%, especially in the lateral segment.CONCLUSION The change in myocardial risk areas and left ventricular contractile function showed positive correlation. 2DE is a simple and noninvasive technique for quantitative detection of left ventricular contractile function in coronary artery disease.

参考文献/References

[1] 周晓东, 钱蕴秋, 臧益民, 等. 二维超声心动图定量分析局部左室收缩功能的计算方法[J]. 中华物理医学杂志, 1991, 13 (1) : 19.

[2] 周晓东, 钱蕴秋, 臧益民, 等. 二维超声心动图评价局部左室收缩功能的实验研究[J]. 中华心血管病杂志, 1992, 20 (4) : 245.

[3] 周晓东, 钱蕴秋, 臧益民, 等. 二维超声心动图评价局部心肌缺血的新指标[J]. 中国医学影像技术杂志, 1994, 10: 163.

[4] Mathias DW, Wann L, Sagar K, et al. Effect of regional myocardial ischemia on Doppler echocardiographic indexes of left ventricular performance: Influence of heart rate, aortic blood pressure, and the size of the ischemic zone[J]. Am Heart J, 1988, 116: 953.

[5] 刘金跃, 周晓东, 钱蕴秋, 等. 舒张期二尖瓣血流与分级心肌缺血的关系—脉冲多普勒超声心动图的动物实验研究[J]. 中华超声影像学杂志, 1994, 3: 255.

备注/Memo

备注/Memo:
收稿日期：2000-02-18.
更新日期/Last Update: 2000-12-01