心肌缺血时血液流变学变化机理及血液稀释的抗心肌缺血作用
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摘要
临床观察与实验研究结果早已证明，血液流变学变化是心肌缺血时全身性反应的重要表现之一，但关于这一变化的发生机理，尚未阐明。为了证明急性心肌缺血时的神经反射活动在阻断冠脉血流后血液流变学异常变化中的作用，本实验研究了阻断交感反射对心肌缺血性血液流变学变化的影响，并进一步观察了低分子右旋糖酐与氟碳乳剂稀释血液对心肌缺血的影响，以求阐明改善血液流变特性是否具有抗心肌缺血作用。
实验在麻醉开胸狗身上进行。主要研究内容包括：
1．观察阻断冠脉左前降支后HCT、Fib、ηp和ηb的变化并对比体循环静脉血与缺血区局部静脉血液流变学变化的特征。
2．研究交感神经反射在血液流变学变化中的作用。具体项目为：(1) 缺血心肌表面浸润利多卡因以抑制缺血区神经末梢感觉传入冲动的产生与传导；(2) 切除双侧星状神经节以阻断向心脏的交感传出冲动；(3) 切断双侧内脏大神经以阻断交感-肾上腺髓质间的联系；(4) 切断双侧内脏大神经后再输注肾上腺素以阐明肾上腺髓质分泌儿茶酚胺在阻断冠脉血流后血液流变学变化中的作用。
3．应用酚妥拉明或切除脾脏以阐明贮血器官内血管收缩在心肌缺血时血液流变学变化中的作用。
4．应用心得安以观察β受体调制的肝细胞纤维蛋白原释放在阻断冠脉血流后血液流变学变化中的作用。
5．观察低分子右旋糖酐与氟碳乳剂稀释血液对心肌缺血时下列指标的影响：(1) 血液流变学异常；(2) 冠脉侧支血流量和侧支供氧量；(3) 心脏收缩和舒张功能；(4) 心肌梗塞范围；(5) 心肌超微结构损伤。
主要研究结果如下：
1．阻断冠脉血流后，血液流变学参数出现明显异常。体循环血液Hct、Fib、ηp和ηb均明显增高，而EDI明显降低。缺血区局部静脉血液Hct、Fib、ηp、EAI和低切变率下全血粘度的变化与体循环相同，但EDI降低和高切变率下全血粘度升高程度明显大于体循环血。
2．缺血区心肌表面浸润利多卡因或切断双侧内脏大神经可显著减轻心肌缺血时血液流变学的异常变化，而切断内脏大神经后再输注肾上腺素可使阻断冠脉血流后血液流变学变化重现。切除双侧星状神经节对血液流变学变化无明显影响。
3．输注酚妥拉明或切除脾脏可使心肌缺血早期(1小时以内)低切变率下全血粘度升高程度明显减轻，并可基本消除阻断冠脉血流后体循环血高切变率下全血粘度的变化。与此相反，输注心得安对低切变率下全血粘度的早期升高和高切变率下全血粘度的变化无明显影响，但可使阻断冠脉血流1小时后出现的Fib、ηp和低切变率下全血粘度变化明显减轻。
4．低分子右旋糖酐具有明显的抗高粘血症作用并可增加冠脉侧支血流量、改善心功能，
It has long been demonstrated both in clinical observations and experimental researches that hemorheologic change is one of the most important reactions to myocardial ischemia. However, the mechanism underlying the changes is still uncertain. In order to clarify the role of nerve reflex activated by coronary occlusion in hemorheologic changes which appear during myocardial ischemia, we studied the effect of blocking the sympathetic reflex on abnormal heraorheologic changes induced by coronary occlusion. Besides, to demonstrate whether improving blood fluidity can alleviate the myocardial ischemia, we observed the effects of hemodilution with dextran-40 or fluorocarbon emulsion(FCE) on myocardial ischemia.
Experiments were performed on anesthetized open-chest dogs.The main projects are:
1.Observe the changes in Hct(microhematocrit centrifuge), Fib(heat precipitation method), η, and η,(NXE-I cone-ptate viscometer) following LAD occlusion and compare the hemorheologic changes of blood from systemic circulation(BSC) with that of blood from coronary vein which drains ischemic region(BIR).
2.Investigate the role of sympathetic reflex in hemorheologic changes by (1) application of lidocaine on the left ventricular epicardial surface to prevent the generation and conduction of impulses from nerve ending located in ischemic myocardium, (2) bilateral section of stellate ganglia to block the efferent impulses to heart, (3) bilateral section of the splanchnic nerves to block the sym-pathetico-adrenal connection and (4) infusion of epinephrine(E) after bilateral section of the splanchnic nerves to clarify the role of adrenal mudulla secre-
实验在麻醉开胸狗身上进行。主要研究内容包括：
1．观察阻断冠脉左前降支后HCT、Fib、ηp和ηb的变化并对比体循环静脉血与缺血区局部静脉血液流变学变化的特征。
2．研究交感神经反射在血液流变学变化中的作用。具体项目为：(1) 缺血心肌表面浸润利多卡因以抑制缺血区神经末梢感觉传入冲动的产生与传导；(2) 切除双侧星状神经节以阻断向心脏的交感传出冲动；(3) 切断双侧内脏大神经以阻断交感-肾上腺髓质间的联系；(4) 切断双侧内脏大神经后再输注肾上腺素以阐明肾上腺髓质分泌儿茶酚胺在阻断冠脉血流后血液流变学变化中的作用。
3．应用酚妥拉明或切除脾脏以阐明贮血器官内血管收缩在心肌缺血时血液流变学变化中的作用。
4．应用心得安以观察β受体调制的肝细胞纤维蛋白原释放在阻断冠脉血流后血液流变学变化中的作用。
5．观察低分子右旋糖酐与氟碳乳剂稀释血液对心肌缺血时下列指标的影响：(1) 血液流变学异常；(2) 冠脉侧支血流量和侧支供氧量；(3) 心脏收缩和舒张功能；(4) 心肌梗塞范围；(5) 心肌超微结构损伤。
主要研究结果如下：
1．阻断冠脉血流后，血液流变学参数出现明显异常。体循环血液Hct、Fib、ηp和ηb均明显增高，而EDI明显降低。缺血区局部静脉血液Hct、Fib、ηp、EAI和低切变率下全血粘度的变化与体循环相同，但EDI降低和高切变率下全血粘度升高程度明显大于体循环血。
2．缺血区心肌表面浸润利多卡因或切断双侧内脏大神经可显著减轻心肌缺血时血液流变学的异常变化，而切断内脏大神经后再输注肾上腺素可使阻断冠脉血流后血液流变学变化重现。切除双侧星状神经节对血液流变学变化无明显影响。
3．输注酚妥拉明或切除脾脏可使心肌缺血早期(1小时以内)低切变率下全血粘度升高程度明显减轻，并可基本消除阻断冠脉血流后体循环血高切变率下全血粘度的变化。与此相反，输注心得安对低切变率下全血粘度的早期升高和高切变率下全血粘度的变化无明显影响，但可使阻断冠脉血流1小时后出现的Fib、ηp和低切变率下全血粘度变化明显减轻。
4．低分子右旋糖酐具有明显的抗高粘血症作用并可增加冠脉侧支血流量、改善心功能，
It has long been demonstrated both in clinical observations and experimental researches that hemorheologic change is one of the most important reactions to myocardial ischemia. However, the mechanism underlying the changes is still uncertain. In order to clarify the role of nerve reflex activated by coronary occlusion in hemorheologic changes which appear during myocardial ischemia, we studied the effect of blocking the sympathetic reflex on abnormal heraorheologic changes induced by coronary occlusion. Besides, to demonstrate whether improving blood fluidity can alleviate the myocardial ischemia, we observed the effects of hemodilution with dextran-40 or fluorocarbon emulsion(FCE) on myocardial ischemia.
Experiments were performed on anesthetized open-chest dogs.The main projects are:
1.Observe the changes in Hct(microhematocrit centrifuge), Fib(heat precipitation method), η, and η,(NXE-I cone-ptate viscometer) following LAD occlusion and compare the hemorheologic changes of blood from systemic circulation(BSC) with that of blood from coronary vein which drains ischemic region(BIR).
2.Investigate the role of sympathetic reflex in hemorheologic changes by (1) application of lidocaine on the left ventricular epicardial surface to prevent the generation and conduction of impulses from nerve ending located in ischemic myocardium, (2) bilateral section of stellate ganglia to block the efferent impulses to heart, (3) bilateral section of the splanchnic nerves to block the sym-pathetico-adrenal connection and (4) infusion of epinephrine(E) after bilateral section of the splanchnic nerves to clarify the role of adrenal mudulla secre-
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102．马新亮 李亮 赵荣瑞 (1983)兔心肌局部缺血和缺氧时的电活动与超微结构的变化 生理学报 35。460—465。
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