远端器官缺血性预处理对心血管功能的影响  

The effects of remote organ ischemic preconditioning on cardiovascular function

作　　者：夏正远[1] Takahiro NISHIDA Willem FLAMENG 

机构地区：[1]湖北医科大学附属第一医院麻醉科,湖北武汉430060 [2]比利时鲁汶大学(K.U.Leuven)实验外科与麻醉学中心

出　　处：《心脏杂志》2001年第5期363-365,368,共4页Chinese Heart Journal

摘　　要：目的 :观察远端器官缺血性预处理 (RPC)对非缺血心脏功能的影响 ,初步探讨 RPC的作用机制。方法 :19只成年绵羊麻醉后随机分为对照组 (n=9)及 RPC组 (n=10 )。测定基础状态 (BS1 )各参数后 ,RPC组动物经历 3次左侧股动脉阻断 5 min及再灌注 5 m in,第三次再灌注后 10 min测 RPC后 (BS2 )各参数。对照组动物不阻断股动脉 ,但于相应时间测定 BS1 及 BS2 各参数。结果 :对照组 BS1 及 BS2 各参数无显著变化。 RPC显著降低平均动脉压(MAP)、外周血管阻力 (SVR)及冠脉循环阻力 (CVR) (P<0 .0 5 ) ;轻度增加心排出量及冠脉血流量 (P>0 .0 5 )。但RPC对心率、左房压、每搏输出量、射血分数及每搏作功无显著影响。 BS2 时 RPC组左室收缩末期压 (L VESP)、左室压力上升及下降最大速率 (± dp/ dtmax)、动脉有效弹回性 (Effective arterial elastance,Ea)均显著低于对照组 (P<0 .0 5 ) ,而心脏收缩及舒张期左室容积下降及增加最大速率 (± dv/ dtmax)无显著变化。结论 :远端器官缺血性预处理降低动脉有效弹性及循环阻力、减弱心脏收缩性的同时 ,并不减弱反而轻度增强心脏泵血功能 ,提高了心肌收缩效率。AIM:To investigate the effects of remote organ ischemic preconditioning (RPC) on the functions of non-ischemic heart. METHODS:19 adult sheep were randomly divided into control group (n=9) and RPC group (n=10) after anesthesia. After the measurement of the baseline parameters (BS_1) in the two groups,RPC was achieved by 3 episodes of 5 min occlusion and 5 min reperfusion of the left iliac artery. Animals in control group did not receive iliac artery occlusion. Parameters after RPC (BS_2) were measured at 10 min following the last time iliac artery reperfusion. RESULTS:There is not significant changes in all parameters of control group. RPC significantly reduced mean artery pressure (MAP),systemic vascular resistance (SVR) and coronary vascular resistance (CVR,P<0.05) and slightly increased cardiac output(CO) and coronary blood flow (CBF). At BS_2,left ventricular end-systolic pressure (LVESP),maximum and minimum of the first derivative of left ventricular pressure (±dp/dt_ max ) as well as the effective arterial elastance (Ea) in RPC group were significantly lower than those in control group. However,RPC did not significantly alter heart rate,left atrium pressure,stoke volume,ejection fraction,stroke work,maximum and minimum of first derivative of left ventricular volume (±dv/dt_ max ). CONCLUSION:Heart pretreated by PRC may have better cardiac function and lower energy cost which might be related to the reduced afterload. Therefore,RPC may have potential benefits in attenuating myocardium ischemia/reperfusion injury.

关 键 词：远端器官 缺血性预处理 股动脉 心血管功能 

分 类 号：R331.3[医药卫生—人体生理学]