经静脉心肌声学造影技术评价ATP敏感钾通道的开放对心肌缺血的保护作用  

Assessment of Protective Effect of K_(ATP) Channel on Ischemic Myocardium by Peripheral Intravenous Myocardial Contrast Echocardiography

作　　者：冯力[1] 刘伊丽[2] 查道刚[2] 黄小波[2] 张稳柱[2] 罗义[2] 

机构地区：[1]广州军区总医院ICU科,广州市510010 [2]南方医院心内科

出　　处：《中国超声医学杂志》2001年第2期81-84,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金!资助 (编号 39870 32 9)

摘　　要：目的 :证实经静脉心肌声学造影 (MCE) ,能够准确的测量缺血和梗死心肌的范围 ,并以此技术研究ATP敏感钾通道 (KATP通道 )开放对缺血心肌的保护作用。方法 :2 1条犬随机分为三组 :IR组 :冠脉左前降支(L AD)闭塞 90 min,再灌注 12 0 min。 NIC组 :L AD闭塞前 10 min,静脉给尼可地尔 10 0μg/ kg,随后给予 10μg/ kg/min持续静滴至再灌注结束。 GL IB+ NIC组 :在 IR组 L AD闭塞前 2 0 min,静脉给予优降糖 0 .3mg/ kg 10 min,随后步骤同 NIC组。各组均在闭塞前状态、闭塞后 1h、再灌注 2 h测定血流动力学指标 ;用图像分析仪测量 TTC染色的危险心肌范围 (AAR)和梗死心肌范围 (IA) ;经静脉注射全氟显行 MCE,在左心室中部水平摄取短轴切面图像 ,冠脉闭塞 1h心肌灌注缺损的范围为 AAR,再灌注 2 h心肌灌注缺损的范围为 IA。结果 :冠脉闭塞 1h,各组心输出量(CO)较基础状态低 (P<0 .0 1) ,再灌注 2 h,NIC组 CO与闭塞前相比明显恢复。TTC测定 AAR范围 :各组之间无显著性差异 (P>0 .0 5 )。TTC测定 IA范围 :NIC组较 IR组和 GL IB+ NIC组明显缩小 (P<0 .0 1)。MCE结果显示 :与 TTC染色的 AAR有显著的相关性 (r=0 .975 )。IR组及 GL IB+ NIC组的 IA范围与 TTC染色的 IA范围也有显著的相关性 (r=0 .949)。结论Objective:To verify that the myocardial risk area and infarct area could be accurately identified with intravenous myocardial contrast echocardiography(MCE)and to assess the protective effect of K ATP channel on ischemic myocardium by the method.Methods:Twenty one dogs were randomly divided into three groups:IR group( n =7):LAD of the dogs were occluded 90min followed by 120min reperfusion.NIC group( n =7):Nicorandil(NIC)100μg/kg was administrated by intravenous injection 10min before occlusion and 10μg/kg/min continuated to the end of reperfusion.GLIB(Glibenclamide)+NIC group(n=7):Before NIC was administrated,the dogs had been pretreated with GLIB 0 3mg/kg 10min.Hemodynamics data were determined in baseline,60min post occlusion,and 120min post reperfusion.By using 2,3,5 triphenyltetrazolium chloride(TTC)staining,the area at risk(AAR)and infarct area(IA)were indicated with image analyzer.MCE was performed during peripheral intravenous injection of Quan Fu Xian.Mid ventricular short axis images were obtained.The perfusion defected 60min after occlusion was defined as AAR and perfusion defected after 120min reperfusion defined as the IA.Results:At 60min post occlusion.the cardiac output(CO)of each group was reduced as compared with that of the baseline( P <0 01),but at 120min post reperfusion in NIC group,the CO value recovered ( P >0 05).With TTC staining,there were no significent differences among three groups in AAR( P >0 05),NIC group produced a marked reduction in infarct size compared with IR and GLIB+NIC group( P <0 01).MCE defined AAR in three groups had good linear relation with TTC staining( r =0 975)at 1h after reperfusion.MCE defined IA in IR and GLIB+NIC groups also had good linear relation with TTC staining( r =0 949).Conclusions:Our study showed that ischemic and infarcted myocardium could accurately identified by MCE technique;K ATP channel opener nicorandil could make marked reduction in infarct size.

关 键 词：经静脉心肌声学造影 ATP敏感钾通道 心肌梗塞 心肌缺血 

分 类 号：R814.43[医药卫生—影像医学与核医学]