猪急性心肌梗死再灌注后无再流与缬沙坦的心功能保护作用  

No-reflow after acute myocardial infarction and reperfusion and protective effects of valsartan on myocardium in a miniswine model

作　　者：赵京林[1] 杨跃进[1] 吴永建[1] 荆志成[1] 尤士杰[1] 杨伟宪[1] 孟亮[1] 田毅[1] 陈纪林[1] 高润林[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,北京市100037

出　　处：《中国临床康复》2005年第35期78-81,共4页Chinese Journal of Clinical Rehabilitation

基　　金：国家自然科学基金(90209038)~~

摘　　要：目的：评价缬沙坦防治猪急性心肌梗死再灌注后无再流的作用。 方法：①实验于2003-05／2004-10在中国医学科学院中国协和医科大学阜外心血管病医院实验外科完成。选用中华小型猪24只。采用随机排列表法将猪分为3组：对照组、缬沙坦组、假手术组，每组3只。②于冠状动脉左前降支远端1／3～1／2处结扎3h，再松解1h建立急性心肌梗死及再灌注模型。缬沙坦组造模后以2mg／(kg·d)剂量，每天混于饲料中喂食给药1次，共3d。对照组造模后无特殊干预措施。假手术组冠状动脉下只穿线，不结扎，不造成急性心肌梗死，也无再灌注。③各组于急性心肌梗死前5min、对照组和缬沙坦组于急性心肌梗死后3h和再灌注后1h用导管法行血流动力学测定(包括心率，收缩压和舒张压，左室收缩末压和左室舒张末压及左心室内压最大上升和下降速率，心排量，肺毛细血管楔压)。④各组使用电磁流量计于急性心肌梗死前5min、对照组和缬沙坦组于再灌注后即刻和再灌注后1h时记录冠状动脉血流量。⑤应用心肌声学造影检查和病理学分析，并计算结扎区心肌范围(急性心肌梗死3h的左心室室壁心肌面积和无心肌显影的灌注缺损区面积与左心室室壁心肌面积之比)、无再流区心肌范围(再灌注60min的无心肌显影灌注缺损区面积与结扎区心肌面积之比)和坏死心肌范围(梗死心肌面积与结扎区心肌面积之比)。⑥两组间比较用t检验，多组间比较用方差分析及q检验。 结果：24只猪均进入结果分析。①血流动力学指标：心肌梗死后3h和再灌注后1h对照组和缬沙坦组左室舒张末压和肺毛细血管楔压明显高于梗死前(P<0．01)；收缩压、舒张压、左室收缩末压、左室内压最大上升和下降速率和心输出量明显低于梗死前(P<0．05～0．01)。对照组左室收缩末压和缬沙坦组左室收缩末压、左心AIM： To evaluate the effects of valsartan on myocardial no-reflow in a mini-swine model of acute myocardial infarction （AMI） and reperfusion. METHODS： The study was performed in the Department of Experimental Surgery at Fuwai Heart Hospital from May 2003 to October 2004. Twentyfour mini-swine were randomized into 3 study groups： 8 in control group, 8 in valsartan-pretreated （2 mg/kg once a day and totally for 3 days） group and 8 in sham-operated group. AMI and reperfusion model was created with three-hour occlusion of the left anterior descending coronary artery followed by one-hour reperfusion. Data on hemodynamics[heart rate（HR）, systolic pressure（SP）, diastolic pressure（DP）, left ventricular end-systolic pressure（LVESP）, left ventricular end-diastolic pressure（LVEDP）, maximal rate of the pressure increase （＋dP/dtmax） and decrease （-dP/dtmax）, cardiac output, and pulmonary capillary wedge pressure] and coronary blood flow volume （CBV） were observed and measured before modeling and instantly and 1 hour after reperfusion, and the area of infarct myocardium and area of no-reflow were evaluated with both myocardial contrast echocardiography in vivo and pathological analysis. Necrosis area was measured with triphenyhetrazolium chloride staining, t test was adopted for comparison between two groups, and analysis of variance and q test for comparison among multiple groups. REUILTS： All the 24 swine were involved in the result analysis. ①In the control and valsartan groups, LVEDP and pulmonary capillary wedge pressure at 3 hours after AMI and 1 hour after reperfusion were significantly higher than before infarction（P 〈 0.01）, while SP, DP, LVESP, ＋dP/dtmax, and cardiac output were significantly declined as compared with before infarction（P 〈 0.05-0.01）; LVESP in the two groups, and -＋dP/ dtmax, and cardiac output in the valsartan group were higher than those 3 hours after AMI （P 〈 0.05）,while ＋ dP/dtmax in the control group and LVEDP in the val

关 键 词：心肌再灌注损伤/药物疗法 缬氨酸/药理学 心肌梗塞 猪 超声检查 

分 类 号：R541.4[医药卫生—心血管疾病]