卡托普利对犬实验性围手术期心肌缺血的影响  

Influence of captopril on perioperative myocardial ischemia in canine model

作　　者：陈鸣和[1,2,3] 王士雯[1,2,3] 王琪 

机构地区：[1]广州军区广州总医院老年病一科 [2]解放军总医院老年心血管病研究所 [3]海军总医院老年病科

出　　处：《中国药理学通报》1998年第4期339-342,共4页Chinese Pharmacological Bulletin

基　　金：军队"九五"重点资助

摘　　要：目的探讨肾素－血管紧张素系统（ＲＡＳ）在围手术期心肌缺血中的作用。方法杂种犬４０只均分为４组：Ⅰ组：对照组；Ⅱ组：心肌梗塞模型组；Ⅲ组：心梗＋胃大部切除组；Ⅳ组：心梗＋卡托普利＋胃大部切除组。取不同部位心脏测肾素和ＡｎｇⅡ，测Ⅲ、Ⅳ组基础、术前和术后的血流动力学和生化指标。结果在Ⅲ组，手术引起左室压最大上升速率及心脏指数下降，致左室舒张末期压、肺动脉嵌压、左室舒张压力下降时间常数（Ｔ值）、总外周阻力（ＴＰＲ）及内皮素、肾素、α－颗粒膜蛋白和ＡｎｇⅡ升高；在Ⅳ组，用药后４０ｍｉｎ，ＴＰＲ和ＡｎｇⅡ下降，Ｔ值和肾素升高；手术使血流动力学回降，其余指标不变。对局部ＲＡＳ、心梗后肾素、ＡｎｇⅡ均增多，手术使ＡｎｇⅡ更多，卡托普利能防止其发生。结论心梗后行胃大部切除术能致左心舒缩功能障碍及激活ＲＡＳ；卡托普利能预防其发生。AIM In order to identify the role of renin angiotensin system (RAS) in perioperative myocardial ischemia, we observed the effect of captopril on heart during perioperative period. METHODS Forty mongrel dogs were randomized for four groups (ten for each group):groupⅠ: control; groupⅡ: myocardial infarction(MI)model; groupⅢ: MI+partial gastrectomy; group Ⅳ: MI+captopril+partial gastrectomy. MI was produced except of the group Ⅰ. All animals were killed by overdose anesthetic and their cardiac samples of different part were taken for assaying of renin and angiotensin Ⅱ (AngⅡ). In the group Ⅲ and Ⅳ, the hemodynamic and biochemical values on baseline, pre and postoperation were examined. RESULTS In group Ⅲ, the partial gastrectomy decreased the maximal rate of left ventricular pressure rise (LV+d p /d t max ), cardiac index (CI), and increased left ventricular end diastolic pressure (LVEDP), time course of isovolumic pressure fall (T constant), total peripheral resistance (TPR), the levels of endothelin (ET), platelet α granule membrane glycoprotein (GMP 140), angiotensin Ⅱ (AngⅡ) and the plasma renin activity (PRA). In group Ⅳ, 40 minutes after administration of captopril, the TPR and plasma AngⅡ concentration were decreased, and the T constant and PRA were increased significantly, the partial gastrectomy attenuated the TPR and T constant, but did not affect other values. For the local RAS of heart, the levels of renin and AngⅡ in the risk and noninfarcted area were increased after myocardial infarction compared with the group Ⅰ . The partial gastrectomy induced further increases in the levels of AngⅡ in the risk and noninfarcted area. In group Ⅳ, there was no change in the level of renin and AngⅡ during perioperative period. CONCLUSIONS Partial gastrectomy performed after myocardial infarction may induce left ventricular systolic and diastolic dysfunction, systemic RAS reaction and local RAS reaction in the heart; captopril can improve left ventricular dysfun

关 键 词：围手术期 心肌缺血 卡托普利 

分 类 号：R654.2[医药卫生—外科学] R972[医药卫生—临床医学]