卡托普利对犬围手术期心肌缺血的预防作用  

Prophylactic Effect of Captopril on Perioperative Myocardial Ischemia in the Canine Model

作　　者：陈鸣和[1] 王士雯[2] 

机构地区：[1]广州军区广州总医院老年病科,510010 [2]解放军总医院老年心血管病研究所,1008553

出　　处：《广东医学》1998年第2期86-88,共3页Guangdong Medical Journal

摘　　要：目的：围手术期心肌缺血主要因应激致冠脉内皮功能障碍，故设想卡托普利可预防其发生。方法：杂种犬40只随机分为4组：Ⅰ组（对照组），Ⅱ组（心梗模型），Ⅲ组（心梗＋胃大部切除术）及Ⅳ组（心梗＋卡托普利＋胃大部切除术）。Ⅲ组及Ⅳ组在心梗后2周行胃大部切除术，测基础值、术前和术后的各指标，用原位杂交观家4组冠脉内皮一氧化氮合酶（NOS）mRNA的表达。结果：在Ⅲ组，手术使LV＋dP／dtmax、CI及一氧化氮下降，引起LVEDP、PCWP、TPR、左室舒张压力下降时间常数（T值）和内皮素升高；在Ⅳ组，用药物分钟，TPR下降，T值升高；手术使血流动力学回降。原位杂交示，在Ⅰ组高度表达，Ⅲ组和Ⅳ组次之，Ⅲ组最低。结论：。心肌梗塞后行胃大部切除术能导致左室行缩及冠脉内皮功能障碍；卡托普利能预防手术所致的心功能障碍。Objective: The perioperative myocardial ischemia(PMI) is mainly caused by increases is sympathetic mervous system activity due to stress, which results in coronary endothelial dysunction,so that it is hypothesized that captopril may improve PMI. Methods: Forty mongrel dogs were randomized for four groups: group Ⅰ:control,group Ⅱ: mycoardial infarction (MI) model, group Ⅲ: MI+subtotal gastrectomy, group Ⅳ MI+ captopril+subtotal gastrectomy. Myocardial infarction was produced by ligation of left anterior descending coronary artery except the group I. In the group, the hemodynamics, plasma emdothelin(ET) and nitric oxide(NO) on baseline, pre-and postoperation were invertigated two weeks after MI. All animals were killed by overdose anesthetic and their cardiac samples of non-infarcted area wereexamined for examining nitric oxide synthase (NOS)mRNA expression levels in vascular endothelial cells. Results: In the group Ⅲ， the operation decreased the maximal rate of left ventricular pressure rise(LV+dP/dtmax),cardiac index(CI) and plasma NO level, and increased left ventricular end diastolic pressure(LVEDP), time-coures of isovolumic pressure fall(T constand), total peripheral resistance (TPR)and the levels of ET. In the group Ⅳ,40 minutes after administration of captopril, the TPR was decreased, and the T constant was increased significantly, the operation attenuated the TPR and T constant, but did not affect the other values. In situ hybridization it was showed that the expression levels of NOS mRNA in the group Ⅰwas the highest, lower in the group Ⅱand Ⅳ,and the lowest in the group Ⅲ.Conclusions :1) subtotal gastrectomy performed after myocardial infarcation may induce left ventricular systolic and diastolic dysfunction, and may produce coronary endothelial dysfunction; 2) captopril can improve left ventricular dysfuntion and endothelial dysfunction induced by abdominal operation.

关 键 词：心肌缺血 预防 卡托普利 围手术期 

分 类 号：R610.5[医药卫生—外科学] R542.201[医药卫生—临床医学]