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目的 观察局部心肌顿抑对全身血流动力学及心肌氧供需平衡的影响。方法 杂种犬 33条 ,常温下 L AD阻断 1 5 min,观察再灌注后全身血流动力学、冠脉流量及缺血心肌氧供需平衡的变化。结果 MAP在冠脉阻断期间稍下降 ,再灌注后升至基础水平 ;HR在缺血 /再灌注过程中均明显增快 ;冠脉阻断后 ,CO、SV、L VSWI均迅疾下降 ,再灌注 5 min略有升高 ,之后进行性下降 ;再灌注后 SVR及 PVR均呈进行性增高 ;再灌注 5 min冠脉流量、MDO2 和MVO2 均显著升高 ,然后同步下降 ;MERO2 在缺血 /再灌注过程中无明显变化。电镜检查 :再灌注 30 min,心肌纤维肿胀 ,间质明显水肿 ,毛细血管淤血 ,线粒体大量空泡。结论 局部心肌顿抑可引起明显的血流动力学变化 ;再灌注初期存在明显的氧耗反常 ,而再灌注后期心肌氧供、氧耗基本相配
Objective To observe the effect of local myocardial stunning on systemic hemodynamics and myocardial oxygen supply and demand balance. Methods 33 dogs were randomly divided into 5 groups: L block at normal temperature for 15 min, and the changes of systemic hemodynamics, coronary flow and myocardial oxygen demand and supply balance after reperfusion. Results MAP decreased slightly during coronary occlusion and rose to basal level after reperfusion. HR increased significantly during ischemia / reperfusion. After coronary occlusion, CO, SV and L VSWI decreased rapidly After 5 min reperfusion, SVR and PVR increased progressively. Reperfusion 5 min coronary flow, MDO2 and MVO2 increased significantly, and then decreased synchronously; MERO2 increased in ischemia / No significant changes during reperfusion. Electron microscopy: reperfusion 30 min, myocardial fibrosis, interstitial edema, capillary congestion, a large number of vacuoles mitochondria. Conclusions Local myocardial stunning can cause obvious hemodynamic changes. At the early stage of reperfusion, there is obvious oxygen consumption anomaly, but oxygen supply and oxygen consumption in the late stage of reperfusion are basically the same