急性心筋虚血に対するIABP及び冠静脈系動脈化手術の効果 : 局所循環の検討を中心として
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概要
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Of a total of 54 mongrel dogs used for this study, either LMCA, LAD or Cx branch of the coronary artery was ligated providing a model of acute myocardial infarction, These dogs were divided into four groups, Three groups underwent IABP, Ao-Cs bypass and Ao-LADV bypass separately, which are the recently developed surgical techniques for the management of acute myocardial infarction. One group was untreated after ligation of the coronary artery for a control study. Epicardial ECG, myocardial surface pH and microcirculation measurement were employed to determine the extent of myocardial ischemic changer for the purpose of evaluating the effects of these techniques. At first, myocardial surface pH a unique technique was compared with epicardial ECC, which provided a close correlation in two techniques (γ= -0.86). This proved that myocardial surface pH recording is a reliable parameter to evaluate ischemic condition of the myocardium. Epicardial ECC and myocardial surface pH at five points in the ischemic and infarcted myocardium were recorded at immediately, 15 minutes, 30 minutes and 1 to 4 hours after coronary ligation. The size of the ischemic and infarcted area of the myocardium were measured by myocardial surface pH mapping. Microcirculation of the ischemic myocardium was measured by cross thermocouples (Shincorder). Histological specimen of the infarcted myocardium was prepared for microscopic examination. In the control group, the ST of epicardial ECG suddenly elevated following coronary ligation but gradually recovered. On the other hand, myocardial surface pH progressively decreased. In the groups treated by IABP, Ao-Cs bypass and Ao-LADV bypass, rapid decrease of ST of epicardial ECG and recovery of myocardial surface pH shortly after beginning of treatment were observed, which reflects favarable effects of these techniques to prevent and improve acute myocardium. The size of the ischemic and infarcted myocardium measured by myocardial surface pH was smaller in the groups with treatment of IABP, Ao-Cs bypass and Ao-LADV bypass than the pretreatment original size in a range of 20 to 30%. Microcirculation of the infarcted myocardium was also improved in the groups with treatment. Pathohistological changes of the myocardium were less remarkable when epicardial ECG and myocardial surface pH improvement was observed in the groups with treatment of IABP, Ao-Cs bypass and Ao-LADV bypass.
- 神戸大学の論文