摘要
目的评价缺血预适应(IPC)防治猪急性心肌梗死(AMI)再灌注后无再流的作用。方法中华小型猪24只随机分成对照组、IPC组和假手术组,每组8只。冠状动脉结扎3h,松解1h制备AMI再灌注模型。AMI前、AMI后3h和再灌注1h后均行血流动力学测定,包括左室收缩压(LVSP)、左室舒张末压(LVEDP)、心排量(CO)和左心室内压最大收缩和舒张变化速率(±dp/dtmax)。各组使用电磁流量计于AMI前5min,对照组和IPC组于再灌注后即刻和1h时记录冠脉血流量,应用心肌声学造影(MCE)检查及病理学分析测定无再流范围(ANR)。结果与AMI前相比,对照和IPC两组AMI后3h和再灌注后1hLVSP、CO和±dp/dtmax均显著下降(P<0.05,P<0.01),LVEDP显著升高(P<0.01);对照组再灌注后1h仅LVSP比AMI后3h显著恢复(P<0.05),±dp/dtmax继续显著下降(P<0.05);IPC组再灌注后1hLVSP、LVEDP、±dp/dtmax和CO均比AMI3h显著恢复(P<0.05,P<0.01)。IPC组MCE和病理染色所测的冠脉结扎区心肌范围高度一致(P>0.05),再灌注后ANR分别为(16.4±2.24)%和(17.5±2.87)%,心肌坏死范围(NA)占LA的(78.4±3.62)%;IPC组结扎区心肌范围与对照组相比,差异无显著性(均P>0.05),但两方法所测ANR和NA均显著小于对照组(P<0.05,P<0.01)。对照和IPC两组再灌注即刻和再灌注后1h冠脉血流量明显低于AMI前(均P<0.01),IPC组再灌注即刻和再灌注后1h冠脉血流量均比对照组显著增加(P<0.05)。结论IPC能有效防治心肌梗死再灌注后无再流,改善心功能,缩小梗死面积。
Objective To evaluate the effects of ischemic preconditioning （IPC） on myocardial noreflow in a mini-swine model of acute myocardial infarction （AMI） and reperfusion. Methods Twenty-four mini-swines were randomized into 3 study groups： 8 in control, 8 in IPC and 8 in sham-operated. Animals in the former two groups were subjected to 3 hours of coronary occlusion followed by 1 hour of reperfusion. Data on hemodynamics and coronary blood flow volume （CBV） were collected, and the area of no-reflow （ANR） was evaluated with both and pathological means. Necrosis area （NA） was staining. Results In control group, left ventricular of left ventricular pressure rise and fall （±dp/dtmax） 0.05, P〈 0.01）, while left ventricular end-diastolic myocardial contrast echocardiography （MCE） in vivo measured with triphenyhetrazolium chloride （TTC） systolic pressure （LVSP）, the maximum change rate and cardiac output （CO） significantly declined （P 〈 pressure （LVEDP） significantly increased at the endof 3 hours of left anterior descending coronary artery occlusion （both P 〈 0.01）, with ±dp/dtmax, further significantly declined （both P 〈0.05） at 1 hour of reperfusion. In IPC group, LVSP, ±dp/dtmax, CO and LVEDP significantly recovered at 1 hour of reperfusion, compared with those in control group. In IPC group, the coronary ligation area was similar on both MCE in vivo and pathological evaluation （P 〉 0.05）, and ANR was both also similarly as high as （16.4±2.24）% and （17.5±2.87）%, respectively, with final necrosis area （NA） reaching （78.4 ± 3.62）%. In IPC group, ANR and final NA were significantly lower than those in control group （P 〈 0.05, P 〈 0.01）. In the control group, coronary blood flow volumn immediately after release of 3 hours occlusion and at 1 hour of reperfusion were significantly lower than the baseline （both P 〈 0.01）. In IPC group, coronary blood flow volumn were significantly higher than those in the control group （both P 〈 0.01）. Conclusion IPC is effective to area prevent myocardial no-reflow, improve left ventricular function and decrease infarct area.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2005年第4期486-490,i0001,共6页
Acta Academiae Medicinae Sinicae
关键词
缺血预适应
无再流
急性心肌梗死
心肌声学造影
ischemic preconditioning
no-reflow
acute myocardial infarction
myocardial contrast echocardiography
作者简介
Corresponding author Tel： 010-88398080, Fax： 010-88390321, E-mail： YYJ@Fuwaihospital.org
