卡维地洛对猪急性心肌梗死再灌注后无再流的影响  

Beneficial effects of carvedilol on myocardial no-reflow in mini-swine models 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治中心,北京100037

出　　处：《第四军医大学学报》2006年第1期14-18,共5页Journal of the Fourth Military Medical University

基　　金：国家自然科学基金(90209038)

摘　　要：目的:评价卡维地洛防治猪急性心肌梗死(AMI)再灌注后无再流的作用.方法:将中华小型猪24只随机分成对照组、卡维地洛组1mg/(kg·d)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、后和再灌注后均行血流动力学测定和心肌声学造影(MCE)检查,最终行病理学分析.结果:①与AMI前相比,对照组AMI后3h主动脉收缩和舒张压(SBP和DBP)、左室收缩压(LVSP),心排量(CO)和左心室内压最大收缩和舒张变化速率(±dp/dtmax)均显著下降(P<0.05),肺毛细血管楔压(PCWP)和左室舒张末压(LVEDP)均显著升高(P<0.01);再灌注后1h仅LVSP显著恢复(P<0.05),±dp/dtmax继续显著下降(P<0.05);而卡维地洛组AMI后3h各项指标变化与对照组相同;但再灌注后1hLVSP,LVEDP,±dp/dtmax和CO均显著恢复(P<0.05)且比对照组更显著(P<0.05).②对照组MCE和病理染色所测的冠脉结扎区心肌范围(LA)高度一致,再灌注后无再流面积(ANR)分别为78.5%和82.3%,心肌坏死面积(NA)占LA的98.5%;而卡维地洛组%LA虽与对照组相当,但两方法所测ANR仅分别为24.9%和25.8%,NA仅为74.4%,均显著小于对照组(P<0.05).③对照组再灌注即刻和再灌注后1h冠脉血流量仅占AMI前的45.8%和50.6%(P<0.01),而卡维地洛组冠脉血流量分别提高到70.6%和74.1%,均比对照组显著增加(P<0.01).结论:卡维地洛能有效地防治AMI再灌注后无再流,改善其心功能,缩小梗死面积.AIM： To evaluate the effects of carvedilol （beta blocker） on myocardial no-reflow in a mini-swine model of acute myocardial infarction （AMI） and reperfusion. METHODS： Twenty-four mini-swine were randomized into 3 groups： control, carvedilol-treatment [ 1 mg/（ kg · d） ] and sham-operation groups （ n = 8 ）. Animals in the former 2 groups were subjected to 3 h of coronary occlusion followed by 60 min of reperfusion. Data on hemodynamics and coronary blood flow volume （CBV） were collected and the area of no-reflow （ANR） was evaluated with both myocardial contrast echocardiography （MCE） in vivo and pathological means. Necrosis area （NA） was measured with triphenyltetrazolium chloride （TTC） staining. RESULTS： ① In control group, left ventricular systolic pressure （ LVSP ）, maximal rate of increase and decline in left ventricular pressure （± dp/dtm max） and cardiac output （ CO ） significantly declined （ P 〈 0.05 ）, while pulmonary capillary wedge pressure （PCWP） and left ventricular end-diastolic pressure （LVEDP） significantly increased at the end of 3 h of left anterior descending （LAD） occlusion （ P 〈 0.01 ）. Compared with those at the end of 3 h of occlusion, ± dp/dt further significantly declined （ P 〈 0.05 ） at 60 min of reperfusion. In carvedilol group, the changes of LVSP, ± dp/dt CO and LVEDP were the same as those in the control group after 3 h of AMI. In contrast, LVSP, ±dp/dt max CO, LVEDP and pulmonary capillary wedge （PCWP） recovered significantly at 60 min of reperfusion. ② In control group, the coronary ligation areas （LA） were similar （P〉0.05） on both MCE in vivo and pathological evaluation and ANR was also both similar as high as 78.5% and 82.3% respectively, with final NA reaching 98.5% of LA. There was no significant difference in LA by both MCE and pathological evaluation between carvedilol and control groups, though ANR by both methods was significantly decreased to 24.9% and 25.8% respective

关 键 词：卡维地洛 无再流 急性心肌梗死 猪 超声 心动描记术 

分 类 号：R542.2[医药卫生—心血管疾病]