カードオプレジアの代替技術

T M Yau¹, R D Weisel, D A Mickle

¹Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.

Circulation

|November 1, 1992

まとめ

心臓外科手術中に異なる心筋梗塞の技術が心筋膜の代謝に影響を及ぼします. 暖かい前段階の心症は酸素消費を最大化し,冷たい心症はアデニン核酸を保存したが,ミトコンドリア機能を抑制した.

科学分野:

心臓病学心臓病学
心臓外科手術について
バイオケミストリーバイオケミストリー

背景:

ノルモ熱性心臓麻痺は臨床的に認められているが,その代謝効果は十分に理解されていない.
様々な心筋膜の保護戦略の代謝的影響に関する研究は限られている.

研究の目的:

冠動脈バイパス移植手術中の3つの心筋麻痺術の代謝効果を比較する.
異なる心筋麻痺の方法に従って心筋筋の代謝回復を評価する.

主な方法:

冠動脈バイパス移植手術を受けた74人の患者が参加したランダム化臨床試験.
患者は,ノルモサーミック・アンテグレイド,ノルモサーミック・レトログラード,または中断的な冷血・アンテグレイドの心臓麻痺を受けた.
測定対象には,心筋の酸素消費量,乳酸生成量,アデニンヌクレオチド,心筋クリエチンキナーゼイソ酵素 (CK-MB) 放出量などが含まれていた.

主要な成果:

暖かい前段階の心臓麻痺は,心筋の酸素消費を最大化しました.
暖かい逆行性心症は,最も高い無酸素乳酸の生産につながった.
冷たい心症はアデニンヌクレオチドの蓄積を引き起こし,ミトコンドリア機能を阻害し,暖かい心症はアデノシントリホスファート (ATP) 前駆体の洗い流出を引き起こした.

結論:

断続的な冷たい心症はアデニンヌクレオチドを保存したが,ミトコンドリア機能を損なっていた.
暖かい前段階の心臓麻痺では,心筋の酸素消費量が高かったことが示された.
臨床的アウトカムや術後のCK-MB放出における有意な差異は,グループ間で観察されなかった.

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