摘要
目的 观察不同正性肌力药单独或联合应用对心肌顿抑的治疗效果。方法 杂种犬33只 ,制作局部心肌顿抑模型后 ,随机分成 6组 ,分别给予生理盐水 (Ⅰ )、肾上腺素 (Ⅱ )、多巴胺(Ⅲ )、米力农 (Ⅳ )、米力农 +肾上腺素 (Ⅴ )和米力农 +多巴胺 (Ⅵ )治疗。于用药后 5、10、2 0、30、6 0min及停药 30min测定血液动力学和缺血区心肌氧供、氧耗变化。分别于用药前和停药 30min切取左室心外膜下心肌组织作电镜检查。结果 Ⅱ、Ⅲ二组用药后CO、冠脉流量虽明显增加 ,但仍低于基础值 ,SVR、PVR无明显变化 ;Ⅳ、Ⅴ及Ⅵ三组用药后CO、冠脉流量显著增加 ,增加幅度依次为 :Ⅵ >Ⅴ >Ⅳ ,同时SVR、PVR显著降低。MERO2 和MDO2 /MVO2 各组间无显著差异。与对照组相比 ,各治疗组用药后MVO2 /MDO2 均趋于下降。心肌超微结构 :停药 30minⅠ、Ⅱ、Ⅲ三组 ,毛细血管仍淤血 ,间质水肿 ,并伴粒细胞浸润 ,但线粒体空泡较前明显减少 ;Ⅳ、Ⅴ及Ⅵ三组停药 30min电镜下可见心肌细胞及间质水肿明显消退 ,毛细血管淤血消失 ,偶见线粒体空泡。结论 1 顿抑心肌对 β受体激动剂反应性降低 ;2 正性肌力药可提高顿抑心肌能量利用效率 ,促进心肌收缩功能的恢复 。
Objective To study the effects of different kinds of positive inotropics epinephrine, dopamine, and milinone on myocardial stunning when given alone or in combination Method Thirty three dogs that with regional myocardial stunning were assigned to be treated with intravenous NS (Ⅰ), epinephrine (Ⅱ), dopamine (Ⅲ), milrinone (Ⅳ), milrinone+epinephrine (Ⅴ) or milrinone+dopamine(Ⅵ) respectively The systemic hemodynamics, myocardial oxygen delivery and consumption of ischemic area were measured at 5, 10, 30, 60min after the inotropics administration and 30min after the drug was stopped Results After the inotropics administration, in group Ⅱ and Ⅲ, CO and CBF increased significantly but still lower than the basal value, SVR and PVR did not change significantly In the combination groups, CO, CBF increased markedly, the order of increasing amplitude was as follows: Ⅵ > Ⅴ > Ⅳ, SVR and PVR decreased markedly at the same time MERO 2 and MDO 2/MVO 2 dod not change significantly but MVO 2/MDO 2 showed a tendency of decreasing after the inotropics administration compared with the control group Electronic microscopy examinations: 30min after the inotropics were stoped, the myocardial ultrastructure of ischemic area did not improved significantly in group Ⅱ and Ⅲversus the group Ⅰ, but in group Ⅵ, Ⅴ and Ⅳ, the interstitial and intracellular edema reduced markedly, the capillary stasis vanished, and very few vacuole could be seen in mitochondria Conclusions 1 The response of stunned myocardium to β agonists decreases 2 Inotropic can restore regional work by restoring mechanical synchrony and improving energy efficiency, the effects of combined inotropics are better than the inotropics given alone in myocardial stunning
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2000年第5期290-294,共5页
Chinese Journal of Anesthesiology
