犬实验性围手术期心肌缺血的冠状动脉内皮功能障碍  

Functional disturbances of endothelium of coronary vessels during perioperative myocardial ischemia

作　　者：陈鸣和[1] 王士雯[1] 

机构地区：[1]广州军区广州总医院老年病一科

出　　处：《中国老年学杂志》1998年第1期41-43,共3页Chinese Journal of Gerontology

基　　金：解放军九五重点资助

摘　　要：杂种犬１５只均分为３组：Ⅰ组：对照组；Ⅱ组：心肌梗死（ＭＩ）模型组，在结扎左前降支２ｗ后取心脏组织；Ⅲ组：ＭＩ＋胃大部切除组，ＭＩ后２ｗ行胃大部分切除术，测定手术前和手术后的血流动力学、血浆内皮素（ＥＴ）及一氧化氮（ＮＯ）。同时，用原位杂交的方法观察３组心脏冠状动脉内皮一氧化氮合酶（ＮＯＳ）ｍＲＮＡ表达水平。结果在Ⅲ组，手术引起ＬＶ＋ｄｐ／ｄｔｍａｘ、ＣＩ及ＮＯ下降，同时致ＬＶＥＤＰ、ＰＣＷＰ、左室舒张压力下降时间常数、总外周阻力以及血ＥＴ升高；ＭＩ后ＮＯＳｍＲＮＡ表达下降，手术使内皮ＮＯＳｍＲＮＡ表达更加减少。提示ＭＩ后行胃大部切除术是研究围手术期心肌缺血较好的动物模型，能致左室舒缩功能障碍；bjective\ The purose is to prove that the stress produced during perioperative myocardial ischemia (PMI) is associated with coronary endothelial dysfunction.Methods\ Fifteen mongrel dogs were randomized for three groups;group Ⅰ as control;group Ⅱ (myocardial infarction MI) heart samples were taken two weeks after ligation of left anterior descending coronary artery;group Ⅲ (MI+partial gastrectomy);partial gastrectomy was performed two weeks after MI,The hemodynamics,plasma endothelin(ET) and nitric oxide (NO) levels were examined and nitric oxide synthase (NOS)mRNA expression levels in endothelial cells of the heart samples in three groups were detected.Results\ The operation decreased the maximal rate of left ventricular pressure rise(LV+dp/dtmax),cardiac index,plasma NO levels,and incresed left ventricular end diastolic pressure,time coruse of isovolumic pressure fall,total peripheral resistance,plasma ET levels.In situ hybridization it was shown that the level of NOS mRNA expresson was decreased in the group Ⅱ,andwas further decreased in the group Ⅲ.Conclusion\ Partial gastrectomy performed after myocardial infartction in dogs is a fair model for examining perioperative myocardial ischemia,and it may produce left ventriclar systolic and diastolic dysfunction,which correlate with coronary endothelial dysfunction; MI only or with gastrectomy decreased NOS mRNA expression in teh coronary endothelial cells.

关 键 词：围手术期 内皮素 心肌缺血 冠状动脉 并发症 

分 类 号：R619.9[医药卫生—外科学] R542.202[医药卫生—临床医学]