MINIMAL CORONARY STENOSES AND LEFT-VENTRICULAR BLOOD-FLOW DURING CPR

被引：19

作者：

KERN, KB

EWY, GA

机构：

[1] Department of Internal Medicine, Section of Cardiology, University ofArizona College of Medicine, Tucson

[2] Tucson Veterans Administration Medical Center, Tucson

来源：

ANNALS OF EMERGENCY MEDICINE | 1992年 / 21卷 / 09期

关键词：

CORONARY STENOSES; CPR;

D O I：

10.1016/S0196-0644(05)80646-8

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: To assess the effect of a 33% coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. Design: Prospective, before and after cardiac arrest and CPR; before and after creation of a 33% stenosis. Setting: The University of Arizona Resuscitation Research Laboratory. Subjects: Ten domestic closed-chest swine with patent coronary stenoses. Interventions: A Teflon(R) cylinder was placed in the mid-left anterior descending coronary artery to create a 33% stenosis. Myocardial blood flow was measured with colored microspheres both proximal and distal to the stenosis during normal sinus rhythm and during CPR. Measurements and main results: During normal sinus rhythm, the stenosis did not alter the amount of myocardial blood flow distribution or quantity. Proximal to the stenosis the endocardial/epicardial flow ratio was 1.49 +/- 0.33, and distal to the stenosis it was 1.50 +/- 0.50. Likewise, during normal sinus rhythm, blood flow proximal and distal to the stenosis did not differ for either the epicardium (79 +/- 9 versus 66 +/- 13 mL/min/100 g) or the endocardium (111 +/- 27 versus 83 +/- 19 mL/min/100 g). However, the distribution of myocardial blood flow was markedly altered during CPR. The resultant endocardial/epicardial flow ratios were significantly less than during normal sinus rhythm, 0.49 +/- 0.11 (three minutes of CPR) and 0.74 +/- 0.07 (eight minutes of CPR) proximal to the stenosis and 0.39 +/- 0.15 (three minutes of CPR) and 0.49 +/- 0.14 (eight minutes of CPR) distal to the stenosis (P < .05 versus normal sinus rhythm). In the presence of a 33% mid-left anterior descending coronary artery stenosis, endocardial blood flow at eight minutes of CPR was significantly lower distal to the stenosis compared with proximal to the stenosis (23 +/- 7 mL/min/100 g versus 74 +/- 18 mL/min/100 g, P < .02). Conclusion: Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.

引用

页码：1066 / 1072

页数：7

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