ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02685.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

SummarySystemic hemodynamics and myocardial metabolism were studied in 21 patients in shock due to acute myocardial infarction. The response to isoproterenol was determined in six, tol‐norepinephrine in eight, and to intra‐aortic counterpulsation in 10 patients. Before treatment, cardiac index was markedly reduced, averaging 1.35 L/min/m2. Mean aortic pressures ranged between 40 and 65 mm Hg, while systemic vascular resistance varied widely, averaging 1,575 dynes‐sec‐cm−5. Decreases in coronary blood flow (mean 68 ml/100 g/min) and in myocardial oxygen consumption (mean 8.11 ml/100 g/min) were associated with abnormally high myocardial oxygen extraction (mean 78%) and with lactate production (mean 9%). Isoproterenol increased cardiac index and heart rate an average of 0.85 L/min/m2and 25 beats/min. Coronary blood flow rose an average of 12 ml/100 g/min in face of unchanged mean aortic pressure, while diastolic aortic pressure fell uniformly. Myocardial lactate metabolism deteriorated. L‐norepinephrine increased mean aortic pressure and coronary blood flow an average of 21 mm Hg and 27 ml/100 g/min. Mean myocardial oxygen consumption rose 2.24 ml/100 g/min. While myocardial lactate production shifted to extraction (mean 12%), myocardial oxygen extraction remained abnormally high (mean 73%). Cardiac index did not improve. Intra‐aortic counterpulsation increased mean aortic pressure and coronary blood flow an average of 15 mm Hg and 23 ml/100 g/min. Myocardial oxygen consumption remained essentially unchanged. Both myocardial lactate and oxygen extraction improved towards normal values (mean 15% and 61%). Cardiac index increased an average of 0.45 L/min/m2. Conclusion: Hemodynamics and myocardial metabolism were markedly abnormal in shock due to acute myocardial infarction. Isoproterenol improved cardiac performance, but myocardial oxygenation deteriorated. Therefore, isoproterenol does not seem to be helpful in coronary shock.L‐norepinephrine improved myocardial perfusion and oxygenation, while cardiac output remained unchanged. Nevertheless,l‐norepinephrine appears to be the vasoactive agent of choice in the initial treatment of coronary shock. Intra‐aortic counterpulsation changed myocardial metabolism towards normal and improved systemic perfusion. Mortality remained unchanged, however, during the three different therapeutic interventions, emphasizing the importance of early recognition of the shock state and of further aggressive diagnostic and the

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02686.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02687.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02688.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

SummaryThe quantitative and qualitative distribution of acid mucopolysaccharides in the mucosa of the proximal and distal portions of the duodenum, ileum, and colon, as well as in the body and pyloric regions of the stomach, were studied. Mucopolysaccharides were extracted and separated as cetylpyridinium complexes into “hyaluronic acid,” “chondroitin sulfate,” and “heparin” fractions and quantitated individually as uronic acid. Extracted acid mucopolysaccharides were purified further by anion exchange chromatography, and the subfractions were characterized according to electrophoretic mobility, anticoagulant activity, metachromatic activity, susceptibility to hyaluronidase, salt quenching of the carbazole color reaction, uronic acid content, hexosamine content, and sulfate content.The chondroitin sulfate fraction was the predominant fraction in all regions. Several subfractions were isolated from both the “chondroitin sulfate” and “hyaluronic acid” fractions. The uronic acid in the “heparin” fraction of all regions yielded one subfraction, which was qualitatively identical to commercial heparin. Acid mucopolysaccharide levels were significantly higher in the stomach mucosa; there, the uronic acid levels in the hyaluronic acid and chondroitin sulfate fractions were significantly higher in the body than in the pyloric region. Short‐term exposure of the duodenum of anesthetized dogs to acetylsalicylic acid had no significant effect on the mucopolysaccharide levels in th

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02689.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02690.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02691.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

ISSN:0028-7113    

DOI:10.1111/j.2164-0947.1972.tb02684.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY