實驗的冠状動脈塞栓症における心筋代謝に關する研究
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Myocardial metabolism in the coronary artery embolisation were studied on the total of 33 closed chest dogs with the technique of coronary sinus catheterization under the condition as natural as possible. Coronary artery embolisation was produced by the injection of suspension of Lycopodium spores through a catheter of 1mm diameter inserted into the left coronary artery under fluoroscopy. Coronary sinus outflow was measured on 4 dogs with the Morawitz canula modified by us. Following results were obtained.1) Immediately after the production of coronary artery embolisation, the decrease in coronary sinus outflow, amounting 17% in average, was observed and the mean arterial blood pressure showed a significant decrease, averaging 14 mmHg. About 2-3 minutes after the embolisation, the increase in coronary sinus outflow of 40% (2.5〜100%) was observed and the arteriaal blood pressure recovered slowly.2) With the rapid increase of coronary blood flow, simultaneous diminution in myocardial oxygen extraction coefficient, averaging 0.27 (0.10〜0.48), was observed and myocardial gas exchanging ratio increased to 0.99.3) Myocardial carbohydrate metabolism after the coronary artery embolisation was studied in 6 dogs. Myocardial glucose extraction ratio decreased 30 minutes after embolisation and in three cases of them the myocardial glucose extraction were in negative balance. Immediately after embolisation the myocardial extraction of lactate and pyruvate were significantly diminished and the concentration of lactate and pyruvate in coronary sinus blood exceeded those of arterial blood. These changes appeared to be rapidly reversible, but in one case of them myocardial lactate extraction were maintained in negative balance even 30 minutes after embolisation. Myocardial citrate extraction was reduced to negative balance, when the catheter was inserted into the coronary artery, but after the caronary artery embolisation, the negative citrate extraction was not significant.4) Within 3 hours following the coronary artery embolisation, the glutamic oxalacetic transaminase showed a marked increase in serum activity and reached a peak after 18-24 hours. Beyond this period decreased the SGO-T activity gradually.The activity of SGO-T in coronary vein blood exceeded 60 units from the arterial blood after 3 hours following embolisation.To short, after the coronary artery embolisation anaerobic glycolysis still proceeds in the heart muscle and the heart reacts rapidly with increased coronary flow to its local ischemia caused by embolisation.At that time, the accumulated anaerobic metabolates are washed out. The fact that lactate and pyruvate in coronary vein blood exceed those in arterial blood indicates incomplete oxidation of carbohydrate in the embolised heart muscle. When it begins to suffer necrosis, the activity of SGO-T in blood increases gradually.
- 社団法人日本循環器学会の論文
- 1959-05-20