高频电切针透壁打孔对犬缺血心肌的血管重建  

Transmyocardial revascularization in dogs with acute myocardial ischemia by an alto frequency needle of electro- surgical generator

作　　者：戴炳光[1] 徐巨林[2] 蔡茗叶[1] 曲崎[1] 张经国[1] 张峰[1] 芦昌慧[1] 杨岷[1] 

机构地区：[1]济南市第四人民医院心外科 [2]齐鲁医院心外科,山东济南250031

出　　处：《第四军医大学学报》2006年第7期596-599,共4页Journal of the Fourth Military Medical University

基　　金：济南市医学科技发展专项基金(2003年A0011号)

摘　　要：目的:在犬的急性缺血心肌上,用高频电切针做透壁性打孔,观察心肌血管重建.方法:健康杂种犬30只,体质量(12.36±2.68)kg,随机分为3组,每组10只.结扎组:结扎前降支第二对角分支以下及回旋支近心尖部分支后关胸.针刺组:先超声测量左室壁厚度,相同于结扎组结扎心脏后,用直径1mm的针头间隔1cm在缺血区打孔(10.10±1.35)个.电针组:针头连接120～160W高频电切能量,相同于针刺组结扎后,在缺血区打孔(9.80±1.69)个.手术后分别于1d,1,2,4和8wk将实验犬处死2只,透射电镜和光镜检查心肌.结果:结扎组的2只犬术后7～23h死亡,1只死于菌痢,1只死因不明.3只犬在打孔时出现短阵室上速.未发现心腔内血栓形成和瓣膜损害.手术后1～2wk,光镜下电针组仍可见针孔,主要是炎症反应较针刺组严重;电镜观察:电针组心肌线粒体损害轻于针刺组,2组皆轻于结扎组(P<0.05).手术后4,8wk光镜观察:血管密度电针组优于针刺组和结扎组(P<0.05);电针组与针刺组纤维化无明显差别,但皆与结扎组有显著差异(P<0.05);术后4,8wk电镜观察:电针组与针刺组线粒体损害轻于结扎组(P<0.05).结论:高频电切针透壁打孔兼有电热能和机械能.120～160W是适宜的能量,热损伤较小,未发现明显炭化层.1～2wk观察到孔道是开放的,随后肉芽组织增生,毛细血管增生,2wk后电针孔道被肉芽组织填塞,产生纤维化.高频电切针透壁打孔的机制类似于激光心肌血运重建术(TMLR),对缺血心肌血管重建是有效的,效果优于针刺打孔.该方法安全、简单、价廉,可以取代激光打孔.AIM： To investigate myocardial revascularization and pathological changes following myocardial acupuncture with a domestic alto frequency needle of electrosurgical generator in dogs with acute myocardial ischemia. METHODS： After an area of acute myocardial ischemia was established, 30 dogs were randomly divided into 3 groups. Of them, 10 dogs served as control group（ Group A）in which no specific treatment was committed after ligation of the second branch of LAD; in another 10 dogs （Group B） ,needle puncture was used; the rest 10 dogs served as electrosurgical needle group （Group C） in which the myocardium of the ischemic area was drilled with a domestic monopolar needle connected to a Valleylab Force 2 electrosurgical generator with pure cut energy at 120 - 160 W. The needle diameter （ 1 mm） and transmural channel density （1 cm） applied in Group B and Group C were the same except no connection to an electrosurgical generator in Group B. Dog hearts were harvested at intervals of 1 d,1,2,4,and 8 weeks after surgery. The contents of microvessel and fibrosis were evaluated with a light microscope and the mitochondria changes were studied with an electron microscope. RESULTS： Two dogs in Group A died 7 and 23 h after operation, respectively. One died of bacillary dysentery, the other due to an unknown cause. Three dogs in Group C developed ventricular tachycardia which lasted 20 - 120 seconds. No mitral valve damages and thrombosis in the chamber of left ventricle were found. Microscopic channels existed in Group C 2 weeks after operation,but not in group B （seen only at 1 week postoperaively）. Channels were blocked by granulation tissue and scar tissue 2 - 8 weeks after operation. Thermal injure was obvious around the channels made by pure cut of electrosurgical generator. Four and 8 weeks after operation, vascular density was significantly elevated in Group C compared with Group A. Fibrosis was more severe in Group A than that in Group C and Group B （P 〈0. 05）. One and 2 weeks aft

关 键 词：心肌血管重建术 激光 血管生成 纤维化 心肌缺血 电外科 

分 类 号：R542.2[医药卫生—心血管疾病]