体外双循环下缺氧预处理对犬心肌的保护作用  

Myocardial protective effect of hypoxic preconditioning with double cardiopulmonary bypass in canine hearts

作　　者：陈林[1] 郑宏[1] 艾来提·塔来提[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830011

出　　处：《中华实验外科杂志》2014年第8期1674-1677,共4页Chinese Journal of Experimental Surgery

基　　金：新疆维吾尔自治区自然科学基金资助项目（2011211B33）

摘　　要：目的 观察在体全心脏实施缺氧预处理的心肌保护效果.方法 选用健康比格犬随机分为空白对照组（C组,n=8）与缺氧预处理组（HPC组,n=8）,分别在全身麻醉下开胸建立双体外循环（体循环＋冠脉循环）模型,HPC组通过冠脉体外循环对在体全心脏实施缺氧预处理（缺氧3 min,复氧5 min,重复3次）,C组不实施缺氧预处理;两组均实施冷灌注使心脏停搏,体外循环60 min后观察犬复跳成功率、心律失常发生率以及除颤次数等临床表现;复跳后30 min结扎冠状动脉的左前降支主干中下1/3,60 min后观察心肌梗死的面积,并取标本做电镜分析;在T1（术前）、T2（体外循环开始前）、T3（复跳后即刻）、T4（缝扎冠状动脉的左前降支30 min后）分别检测肌钙蛋白水平和心肌酶谱;并观察两组间心脏舒缩功能和心肌超微结构的影响.结果 HPC组在T3时点心肌酶谱水平高于C组（P＜0.05）,但在T4时点HPC组的心肌酶谱和肌钙蛋白均显著低于C组（P＜0.05）;HPC组在一次性复跳率和除颤例数数上均有显著低于空白对照组（7/8比4/8、1/8比5/8,P＜0.05）,HPC组心梗面积显著低于C组[（15.37±1.64）％比（29.77±3.38）％,P＜0.05],电镜显示HPC组线粒体结构的损害及心肌细胞水肿的程度轻于C组.结论 在体全心脏缺氧预处理对于心肌细胞有显著的保护作用,能够提高心肌细胞对缺氧的耐受能力.Objective To investigate the myocardial protective effect of hypoxic preconditioning in thein vivo canine hearts.Methods Healthy beagle dogs were randomly divided into two groups：the hypoxic preconditioning group （HPC group,n =8） and the control group （C group,n =8）.The dog model of the double cardiopulmonary bypass （systemic and coronary circulation） was established after chest opening under general anesthesia.In HPC group,dog hearts were perfused by the coronary circulation and subjected to hypoxic preconditioning （3 min of hypoxia followed by 5 min of reoxygenation,repeated 3 times）.The animals in C group were not subjected to hypoxic preconditioning.Both groups underwent cold cardioplegia perfusion through coronary circulation to induce cardiac arrest.At 60 min after cardiopulmonary bypass,we observed one-time rebeat rate,the incidence of arrhythmia and electric defibrillation times.At 30 min after rebeating,the left anterior descending coronary arteries were ligated with suture at the lower 1/3.The myocardial infarction area size was observed 60 min later,and samples were taken for examination by electron microscopy.At T1 （before operation）,T2 （before cardiopulmonary bypass）,T3 （immediately after the rebeat）,and T4 （30 min after the ligation of left anterior descending coronary）,the troponin and myocardial enzymes spectrum were measured.Cardiac function and myocardial structure were also observed in both groups.Results Myocardial enzymes at T3 were higher in HPC group than in C group （P ＜ 0.05）,and myocardial enzymes and troponin at T4 were significantly lower in HPC group （P ＜ 0.05）.As compared with C group,one-time rebeat rate and defibrillation times were significantly reduced in HPC group （7/8 vs.4/8 and 1/8 vs.5/8,P＜0.05）.The infarct area size was significantly smaller in HPC group than in C group [（15.37 ± 1.64） ％ vs.（29.77 ± 3.38） ％,P ＜ 0.05],and electron microscopy revealed that the damage of mitochondrial structure and edema of card

关 键 词：缺氧预处理 体外循环 心肌保护 

分 类 号：R654.1[医药卫生—外科学]