急性冠動脈閉塞による心筋 pH 低下並びに心筋の代謝変動に及ぼす胸部硬膜外麻酔の影響に関する実験的研究

概要

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The effect of thoracic epidural anesthesia (TEA) on ischemic myocardium was examined in intravenously anesthetized, open-chest dogs. Ischemia induced by brief coronary occlusion caused an elevation of the ST segment in epicardial ECG, and a reduction of myocardial pH and myocardial contractile force. TEA significantly decreased blood pressure, heart rate and coronary flow, whereas it did not affect myocardial pH and myocardial contractile force. TEA attenuated ischemia-induced elevation of ST segment and reduction of myocardial pH. Since similar results were observed after bilateral stellectomy and extirpation of T2-5 sympathetic trunks (SGX), the protective effect of TEA on myocardial pH and ST segment during ischemia should be mediated by the sympathetic nervous system. The effect of TEA on the ischemic myocardium was not influenced by restoration of blood pressure and heart rate to the pre-TEA levels, induced by blood transfusion and atrial pacing, respectively. Neither TEA nor SGX affected the levels of ATP, CrP and lactate in the ischemic myocardium. In conclusion, TEA reduced the myocardial ischemic injury (as evaluated by anielevation of the ST segment in epicardial ECG and myocardial pH decrease) caused by acute coronary occlusion. This effect can not be ascribed to hemodynamic changes induced by TEA.
札幌医科大学の論文
1987-02-02