上胸段硬膜外阻滞对大鼠心肌缺血-再灌注的保护作用  

Protective effect of high thoracic epidural block on myocardium against ischemia-reperfusion injury in rats

作　　者：刘瑶[1] 黄宁[1] 李冰[1] 王志刚[1] 

机构地区：[1]哈尔滨医科大学附属第三医院麻醉科,150081

出　　处：《临床麻醉学杂志》2013年第12期1210-1213,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨上胸段硬膜外阻滞（HTEB）对大鼠心肌缺血一再灌注损伤的保护作用及机制。方法40只Wistar大鼠随机分为四组，每组10只。除C组仅穿线外，其他各组均在左冠状动脉前降支下穿线并结扎。在结扎前15min，HTEB组和5-HD组硬膜外给予0．5％罗哌卡因125μl／kg，C组和IR组给予等量生理盐水，5-HD组结扎前静脉注入5-HD5mg／kg。记录开胸前（T1）、缺血前（T2）、缺血30min（T3）、再灌注1h（T4）、再灌注2h（T5）的HR、MAP，以及T1、T3～T5时血清肌钙蛋白T（cTnT）含量。高效液相色谱法测定心肌ATP的含量。结果与T1时比较，T4、T5时C组和T3～T5时IR组、HTEB组和5HD组HR明显减慢，MAP明显降低（P〈0．05）。与c组比较，T3～T5时IR组、HTEB组和5-HD组HR明显减慢；T3、T4时IR组和5-HD组MAP明显降低（P〈0．05）。与HTEB组比较，T3～T5时IR组HR明显减慢，MAP明显降低（P〈0．05）。与T1时和C组比较，T4、T5时IR组、HTEB组和5-HD组cTnT含量明显升高（P〈0．05）。与HTEB组比较，T4、T5时IR组和5-HD组cTnT含量明显升高（P〈0．05）。与C组比较，IR组、HTEB组和5-HD组心肌细胞ATP含量明显降低（P〈0．05）。与HTEB组比较，IR组、5-HD组心肌细胞ATP含量明显降低（P〈O．05）。结论HTEB能够减轻大鼠心肌缺血-再灌注损伤，机制可能与线粒体敏感性钾通道的开放及ATP消耗减少有关。Objective To evaluate the protective effect of high thoracic epidural block（HTEB） against ischemia-reperfusion injury on myocardium and its possible mechanism. Methods Forty Wistar rats were randomly divided into four groups （n=10 each） ：control group （group C） ,ischemiareperfusion group （group IR）, high thoracic epidural block group （group HTEB） and 5- hydroxydecanoate group （group 5-HD）. To establish the ischemia-reperfusion model,except in group C,the left anterior descending coronary artery of rats in other groups were ligated. Rats in group HTEB and group 5-HD were received 0.5% ropivacaine 125 μl/kg to epidural space fifteen minutes before occlusion of coronary artery, while rats in group C and group IR were injected normal saline instead of 0.5 % ropivacaine. Rats in group 5-HD were injected 5-hydroxydecanoate intravenously, ten minutes before the occlusion of coronary artery. HR and MAP were recorded at pre-thoracotomy （Tl）, pre-ischemia（T2 ）, 30 min after ischemia（T3 ）, 1 h after reperfusion（T4 ）, and 2 h after reperfusion（T5 ）. The troponin T level was detected hy using enzyme linked irnmunosorbent assay at T1, T3 T5, and the ATP level was detected by using high efficiency liquid chromatography. Results Compared with T1, HR was significantly slower, MAP of group C was significantly lower at T4, T5, and those of group IR, group HTEB and group 5-HD at T3-T5 （P〈0.05）. Compared with group C, HR of group IR, group HTEB and group 5-HD was significantly slower at T3-T5 ; MAP of group IR and group 5 HD was significantly lower at T3 -T4 （P〈0.05）. Compared with group HTEB, HR of group IR was significantly slower, MAP of group IR was significantly lower at T3-T5 （P〈 0.05）. The level of tropnin-T in group HTEB was obviously lower than that of group IR and group 5- HD （P〈0. 05）,the level of ATP in group HTEB was obviously higher than that of group IR and group 5-HD （P〈0. 01）. Conclusion HTEB might alleviate the myocardial ischemia-reperfusi

关 键 词：硬膜外阻滞 心肌缺血-再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]