福辛普利对猪急性心肌梗死再灌注后无再流的影响  

Beneficial effects of fosinopril on myocardial no-reflow in a mini-swine model of acute myocardial infarction and reperfusion

作　　者：赵京林[1] 杨跃进[1] 荆志成[1] 吴永建[1] 尤士杰[1] 杨伟宪[1] 孟亮[1] 田毅[1] 陈纪林[1] 高润霖[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院冠心病诊疗中心,北京100037

出　　处：《中华心血管病杂志》2005年第7期638-642,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金资助项目(90209038)

摘　　要：目的评价福辛普利防治猪急性心肌梗死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、福辛普利组(1mg·kg-1·d-1)和假手术组,每组8只。冠状动脉结扎3h,松解1h制备急性心肌梗死再灌注模型。梗死前、后和再灌注后均行血液动力学测定和心肌声学造影检查,最终行病理学分析。结果心肌声学造影和病理染色所测的冠状动脉结扎区心肌范围(LA)差异无统计学意义。与对照组相比,福辛普利可促进急性心肌梗死后心功能的恢复,增加再灌注后1h冠状动脉血流量(对照组50·6%,福辛普利组72·1%,P<0·01),减少无再流面积(对照组心肌声学造影和病理:78·5%和82·3%LA;福辛普利组心肌声学造影和病理:24·5%和25·2%LA,P均<0·01),减少心肌坏死面积(对照组98·5%,福辛普利组88·9%LA,P<0·05)。结论福辛普利能有效地防治心肌梗死再灌注后无再流。Objective To evaluate the effects of fosinopril on myocardial no-reflow in a mini-swine model of acute myocardial infarction and reperfusion. Methods Twenty-four mini-swines were randomized into 3 study groups： 8 in control group, 8 in fosinopril-treated group（ 1mg·kg^-1 ·d^-1） and 8 in shamoperated group. Animals in the former two groups were subjected to 3 hours of coronary occlusion followed by 60 minutes of reperfusion. Data on haemodynamics and coronary blood flow volume （CBV） were collected, and the area of no-reflow was evaluated with both myocardial contrast echocardiography （MCE） in vivo and pathological means. Necrosis area was measured with triphenyltetrazolium chloride （TI＇C） staining. Results （1） In the control group, systolic and diastolic blood pressure （SBP and DBP）, left ventricular systolic pressure（LVSP）, maximal rate of increase and decrease in left ventricular pressure （ ± dp/dtmax） and cardiac output（CO） significantly declined （ P 〈0. 05-0. 01 ） , while left ventricular end-diastolic pressure （LVEDP） and pulmonary capillary wedge pressure （PCWP） significantly increased at the end of 3 hours occlusion of left anterior descending artery （both P 〈 0. 01 ）. Compared with those at the end of 3 hours of occlusion, ± dp/dtmax further significantly declined （ P 〈 0. 05 ） at 60 minutes of reperfusion. In the fosinopril group, the changes of SBP and DBP, LVSP, ± dp/dtmax, CO, LVEDP and PCWP were similar as those in the control group after 3 hours of acute myocardial infarction. In contrast, LVSP, ± dp/dtmax, CO, LVEDP and PCWP recovered significantly at 60 minutes of reperfusion. （2） In the control group, the coronary ligation area was similar on both MCE in vivo and pathological evaluation, and the area of no-reflow was similarly as high as 78.5% and 82.3% , respectively, with final necrosis area reaching 99% of ligation area. In the fosinopril group, there was no significant difference in ligation area on both MCE and pathol

关 键 词：心肌梗塞 再灌注损伤 福辛普利 无再流 急性心肌梗死后 再灌注模型 小型猪 心肌声学造影 病理学分析 冠状动脉结扎 

分 类 号：R542.22[医药卫生—心血管疾病] R743.3[医药卫生—内科学]