体外循环缺血再灌注心肌胰岛素抵抗与心功能障碍的关系  

Relationship between myocardial insulin resistance and heart dysfunction during myocardial ischemia-reperfusion in cardiopulmonary bypass

作　　者：隋东虎[1] 石应康[1] 郭应强[1] 王儒蓉[2] 刘斌[2] 李坚[2] 

机构地区：[1]华西医科大学附属第一医院胸心血管外科,成都610041 [2]华西医科大学附属第一医院麻醉科,成都610041

出　　处：《中华实验外科杂志》2002年第3期208-210,共3页Chinese Journal of Experimental Surgery

基　　金：中国博士后科学基金资助项目(中博基[2 0 0 0 ] 2 3)

摘　　要：目的　探讨体外循环缺血再灌注心肌胰岛素抵抗与心功能障碍的关系。方法　 1 2条雄性杂种狼犬 ,按体外循环主动脉阻断时间不同分为两组 ,组Ⅰ (6条 ) :主动脉阻断 2 5min ;组Ⅱ(6条 ) :主动脉阻断 1 50min。分别于转流前、开放主动脉后 1 0、30、60min时同时采集动脉、冠状静脉窦血标本并行右房心肌组织活检 ,测定血浆葡萄糖、乳酸、胰岛素、C肽、胰高血糖素、皮质醇、生长激素浓度和心肌组织糖原含量 ,同时监测围手术期血流动力学。结果　缺血再灌注后血浆葡萄糖、乳酸、胰岛素、C肽、胰高血糖素、皮质醇及生长激素浓度均不同程度明显增高 ,于再灌注 1 0～ 30min达峰值 (与转流前比较 ,P值均 <0 .0 5) ,同时心肌糖原分解明显增强 ,而对葡萄糖的摄取、利用严重障碍。与组Ⅰ比较 ,组Ⅱ心肌胰岛素抵抗程度更重、持续更久且终止体外循环后心脏指数、每搏指数及左室每搏工作指数均显著降低 (P值均 <0 .0 5)。结论　体外循环缺血再灌注心肌胰岛素抵抗程度与心功能障碍的发生密切相关 。Objective To explore the relationship between myocardial insulin resistance and heart dysfunction during myocardial ischemia reperfusion in cardiopulmonary bypass (CPB).Methods Twelve male mongrel wolf dogs undergoing CPB were divided into two groups:group I (n=6), aortic cross clamp for 25?min; group Ⅱ (n=6),aortic cross clamp for 150?min.The plasma concentrations of glucose lactate,insulin,C peptide,glucagon,cortisol,growth hormone as well as myocardial glycogen contents were detected at pre bypass, reperfused 10?min,30?min and 60?min respectively.Systemic hemodynamics was measured perioperatively.Results During myocardial ischemia reperfusion,the plasma concentrations of glucose, lactate, insulin, C peptide, glucagon,cortisol and growth hormone were all significantly increased and reached their peak levels at reperfused 10?min and 30?min as compared with prebypass levels (all P<0.05),meanwhile myocardial glycogenolysis was significantly increased and there was severe dysfunction in myocardial glucose uptaking and utilization.In comparison with group I,the degree of myocardial insulin resistance was markedly increased and lasted longer time,accompanied with a significant reduction of CI, SVI and LVSWI after weaning from CPB.Conclusion During myocardial ischemia reperfusion, the degree of myocardial insulin resistance is closely associated with heart dysfunctional occurrence.Myocardial insulin resistance may be an important factor to trigger the mechanism of reduced myocardial glucose oxidation resulting in heart dysfunction.

关 键 词：体外循环 缺血再灌注 心肌 胰岛素抵抗 心功能障碍 

分 类 号：R654.2[医药卫生—外科学]