乳化异氟烷对兔心肌缺血再灌注损伤的保护作用  

作　　者：Yan Rao Yan-lin Wang Wen-sheng Zhang Jin Liu 饶艳(译) 

机构地区：[1]Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, People's Republic of China [2]Department of Anesthesiology, State Key Laboratory of Biotherapy of Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, Sichuan, People's Republic of China [3]不详

出　　处：《麻醉与镇痛》2009年第3期88-94,共7页Anesthesia & Analgesia

摘　　要：背景比较乳化异氟烷和吸入异氟烷的心肌保护效应。方法给32只兔进行临时结扎左冠状动脉前降支30分钟以造成心肌缺血，然后再灌注3小时。在结扎左前降支前，随机将兔分为4组（每组8只）：c组，无缺血前预处理措施；IS组：吸入呼气末浓度为1．1％异氟烷；EI组：持续泵注8％乳化异氟烷以达到呼气末浓度为0．64％；IN组：持续泵注30％脂肪乳。在缺血前30分钟进行预处理，异氟烷组随后还有15分钟的洗脱时间。再灌注3小时后取标本测定心肌梗死面积、乳酸脱氢酶和肌酸激酶活性及线粒体超微结构。结果IS组和EI组在再灌注3小时后心肌梗死面积明显低于C组和Ⅲ组（20％±8％，18％±8％，39％±6％和34％±9％，P〈0．01）。IS组和EI组的心肌梗死面积无差异，C组和IN组的心肌梗死面积亦无差异。心肌再灌注3小时后IS组和EI组血浆乳酸脱氢酶（456±58U／L，451±54U／L）和肌酸激酶活性（1725±230U／L，1686±444U／L）明显低于C组（676±82U／L，2373±529U／L；P〈0．01）。IS组和EI组心肌线粒体超微结构改变比对照组减轻。结论静脉注射乳化异氟烷对兔心肌缺血再灌注有保护作用，其效应与吸入异氟烷相似。BACKGROUND： In this study, we examined the cardioprotective effects of parental emulsified isoflurane compared with inhaled isoflurane. METHODS： Thirty-two rabbits were subjected to 30 min of myocardial ischemia induced by temporary ligation of the left anterior descending coronary artery followed by 3 h of reperfusion. Before left anterior descending coronary artery occlusion, the rabbits were randomly allocated into one of four groups （eight for each group）： group C, no ischemia preconditioning treatment; group IS, inhaled isoflurane 1.1% end-tidal; group EI, a continuous infusion of 8% emulsified isoflurane to an end-tidal concentration of 0. 64%; and group IN, a continuous infusion of 30% Intralipid started 30 min. Treatments were started 30 min before ischemia followed by a 15 rain washout period for isoflurane groups. Myocardial infarct volume, lactate dehydrogenase, and creatine kinase levels were measured and changes in mitochondrial ultrastructure assessed after 3 h myocardial reperfusion. RESULTS： Myocardial infarct size 3 h after reperfusion was lower in groups IS and EI compared with groups C and IN （20% ± 8%, 18% ± 8%, 39% ± 6%, and 34%± 9%, respectively, P 〈 0.01 ）. There were no differences in myocardial infarct size between groups IS and EI or between groups C and IN. Plasma lactate dehydrogenase and creatine kinase levels were lower in group IS （456± 58 U/L and 1725± 230 U/L） and group EI （451 ±54 U/L and 1686 ±444 U/L） 3 h after myocardial reperfusion compared with groups C （676 ±82 U/L and 2373 ±529 U/L; P 〈0.01 ）. Mitochondrial ultrastructure changes were less pronounced in groups IS and EI compared with group C. CONCLUSIONS： Our results indicate that, in rabbits, IV emulsified isoflurane provides similar myocardial protection against ischemia-reperfusion injury as inhaled isoflurane.

关 键 词：心肌缺血再灌注损伤 乳化异氟烷 保护作用 心肌梗死面积 肌酸激酶活性 冠状动脉前降支 线粒体超微结构 呼气末浓度 

分 类 号：R542.2[医药卫生—心血管疾病] R654.2[医药卫生—内科学]