冠状静脉逆灌注对犬缺血心肌的保护作用  

The Protective Effects of Coronary Venous Retroperfusion on Ischemic Myocardium in Dogs

作　　者：张成喜[1] 潘思年[2] 符永玫[1] 刘旭辉[1] 刘金来[3] 张书刚[3] 

机构地区：[1]中山医科大学附属第三医院急诊科 [2]中山医科大学附属第三医院儿科 [3]中山医科大学附属第三医院心内科,广东广州510630

出　　处：《中山医科大学学报》2001年第2期111-115,共5页Academic Journal of Sun Yat-sen University of Medical Sciences

基　　金：广东省卫生厅基金资助项目! (A1999177)

摘　　要：【目的】探索一种简便的冠状静脉逆灌注方法 ,了解其有效性和安全性。【方法】健康成年犬 13条 ,随机分为逆灌注组 (n =7)和对照组 (n =6 )。开胸结扎左冠状动脉前降支 (LADA) ,逆灌注导管经右颈外静脉送入冠状静脉窦并进一步插至心大静脉 (GCV)远端 ,动脉血由左颈总动脉引出 ,以自身动脉血压为动力进行持续逆灌注。逆灌注组于LADA结扎后 5min开始持续逆灌注 ,共 6h ;对照组同样进行插管但不灌注。观察血流动力学、心电图、血清生化及形态学改变。【结果】逆灌注组血流动力学较稳定 ( P <0 0 5～ 0 0 1)。LADA结扎后两组缺血中心区心外膜心电图ST段均明显抬高 ,30min后逐渐回降 ,逆灌注组回降速度较快 (P <0 0 1)。与逆灌注组相比 ,对照组血清肌酸激酶 MB(CK MB)明显升高 ,一氧化氮 (NO)水平明显下降 (P <0 0 5～ 0 0 1)。对照组和逆灌注组缺血心肌发生梗死的面积分别占 ( 76 2± 4 7) %和 ( 38 8± 7 3) % (P <0 0 1)。光镜下 ,逆灌注组前室间静脉 (LADV)及其小属支内膜结构完整 ,无明显损伤 ;两组均未见到出血性梗死。【结论】采用简便的冠状静脉逆灌注方法可明显减轻心肌的缺血性损伤 ,减小心肌梗死面积 ,稳定血流动力学 。Objective To investigate the efficacy and safety of a simplified coronary venous retroperfusion method. Methods Thirteen adult mongrel dogs were allocated randomly into retroperfusion group (n=7) and control group (n=6). All dogs underwent six hours of ischemia imposed by ligating the proximal part of the left anterior descending coronary artery (LADA). Retroperfusion catheter was inserted through the right external jugular vein until its tip was at the distal part of the great cardiac vein (GCV). Arterial blood was drained from the left carotid artery. In the retroperfusion group, retroperfusion began 5 min after the ligation of LADA and persisted throughout the six hour experiment. In the control group, the retroperfusion catheter was inserted the same as in the retroperfusion group but without retroperfusion. Hemodynamics, electrocardiographs, serum biochemistry and morphologic changes were observed. Results The hemodynamics were more stable in the retroperfusion group than in the control group (P<0 05～0 01). Soon after the LADA ligation epicardial ST segments were greatly elevated in both groups and 30 min later it began to drop gradually, but the drop in the retroperfusion group was faster (P<0 01). During the experiments the value of creatine kinase MB(CK MB) elevated and nitric oxide (NO) dropped more obviously in the control group than in the retroperfusion group (P<0 05～0 01). The infarction area, expressed as percentage of the ischemic area, was (76 2±4 7)% in the control group and (38 8±7 3)% in the retroperfusion group, (P<0 01). The structures of the intima of left anterior descending coronary vein (LADV) and its subordinating veins had no obvious injuries under light microscope, and in both groups there were no hemorrhagic infarctions. Conclusion Simplified coronary venous retroperfusion can lessen ischemic injuries, reduce myocardial infarction size,stabilize hemodynamics and made no obvious damages to coronary veins and myocar

关 键 词：心肌缺血 冠状血管 血液灌注 冠状静脉逆灌注 心肌保护 

分 类 号：R542.22[医药卫生—心血管疾病]