心肌缺血预处理后亚低温对家兔急性心肌梗死面积的影响  

The effect of mild hypothermia after preconditioning on myocardial infarction size in rabbits

作　　者：王志忠[1] 孟庆义[1] 王士雯[2] 马勇[1] 钱远宇[1] 

机构地区：[1]中国人民解放军总医院急诊科,北京100853 [2]中国人民解放军总医院老年心血管病研究所,北京100853

出　　处：《中华急诊医学杂志》2004年第9期589-591,共3页Chinese Journal of Emergency Medicine

基　　金：教育部留学回国人员科研启动基金 ( 2 0 0 3年 )

摘　　要：目的　探讨心肌缺血预处理后亚低温治疗对家兔急性心肌梗死面积的影响。方法　 14只家兔随机分为为常温组和亚低温组 ,结扎前降支建立急性心肌梗死模型。亚低温组通过物理降温使结扎后 30min体温降到 35℃以下 ,常温组体温维持在 38℃以上。取心脏染色切片 ,计算梗死心肌、濒危心肌和左室心肌的重量。结果　 (1)亚低温组梗死心肌占濒危心肌的比例分别为 [(32 7± 6 5 ) %和 (4 4 9± 10 7) ,P=0 0 34];占左室心肌的重量比例分别为 [(5 8± 1 7) %和 (9 4± 2 0 ) % ,P =0 0 0 5 ]。 (2 )组织学检查显示亚低温组梗死心肌重量明显低于常温组 ,分别为 (0 38± 0 11)g和 (0 5 9± 0 14 )g ,P =0 0 13]。 (3)亚低温组梗死后 3h血清CK MB活性改变与常温组相近 [(3113 0± 135 1 8)U/L对 (2 733 4± 1792 3)U/L ,P=0 6 79]。 (4 )亚低温组心电图胸前导联抬高幅度之和与常温组无显著性差异 (5 1 4mV± 19 4mV对4 1 0mV± 2 7 6mV ,P =0 4 5 7)。结论　心肌缺血预处理后给予亚低温治疗可减少家兔急性心肌梗死的面积。Objective To study the effect of mild hypothermia(MH) on the myocardial infarction size after ischemic preconditioning.Methods Fourteen rabbits were randomly divided into 2 groups: mild hypothermia and control groups. Each group underwent left anterior descending to establish acute myocardial infarction model.The core temperature in the mild hypothermia group dropped to 32℃～35℃ 30 minutes after occlusion, while the control group temperature were kept above 38℃. The myocardial area at risk and the infarction size were determined with Evans blue dye and triphenyl tetrazolium chloride( TTC ). Results (1)The percentage of myocardial infarction size accounting the risk zone (5.8%±1.7% vs 9.4%±2.0%,P=0.005) and the percentage of myocardial weight accounting left ventricular myocardium were lower than the control group(32.7%±6.5% vs 44.9%±10.7%, P=0.034).(2) The weight of infarction myocardium in the mild hypothermia group showed lower than the control (0.38 g±0.1 1g vs 0.59 g±0.14g, P=0.013).(3) Changes of serum CK-MB activities in mild hypothermia group showed no significant difference with the control (3113.0 U/L±1351.8 U/L vs 2733.4 U/L±1792.3U/L. P=0.679).(4) The total elevated amplitude of ST segment in chest leads V1, V3 and V5 in the mild hypothermia group were the same as the control (51.4 mV±19.4mV vs 41.0 mV±27.6mV. P=0.4565).Conclusion Mild hypothermia may reduce infarction size in the rabbits after ischemic preconditioning, and increase survived myocardium in the risk zone.

关 键 词：亚低温治疗 急性心肌梗死 心肌缺血预处理 结扎 左室心肌 家兔 心电图 常温 比例 重量 

分 类 号：R542.22[医药卫生—心血管疾病]