动脉瘤合并心肌损伤与血管痉挛关系的研究  

Relationship between aneurysm complicated myocardial injury and vasospasm

作　　者：张浩明[1] 方志成[1] 郭秀萍[1] ZHANG Hao-ming FANG Zhi-cheng GUO Xiu-ping(Department of Intensive Care Unit, Affiliated Taihe Hospital of Hubei Medicinal College, Shiyan, Hubei, 442000, Chin)

机构地区：[1]湖北医药学院附属十堰市太和医院重症医学科,湖北十堰442000

出　　处：《心血管康复医学杂志》2016年第5期491-495,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：湖北省自然科学基金面上项目(2014CFB314)

摘　　要：目的:探讨动脉瘤合并心肌损伤的病理神经机制及其与血管痉挛关系,寻找有效防治方法。方法:60只日本大耳白兔按照改良胰弹性蛋白酶诱导动脉瘤方法制作颈总动脉瘤模型(通常反映颅内动脉瘤),术后根据心电图ST段有无抬高分为ST段抬高组(25只)和ST段无抬高组(21只),同时以心脏超声、心肌肌钙蛋白I(cTnI)评估心肌损伤情况,术后以血管超声动态测定颈动脉瘤血管扩张内径、局部血流速度,评估血管痉挛与颈总动脉瘤合并心肌损伤之间关系。结果:ST段抬高组术后3d较1d、5d颈总动脉瘤血管内径明显变小,远近端血流速度明显加快,其后恢复,术后7d瘤样血管内径再度明显变小,血流速度明显加快(P<0.05或<0.01)。与无ST段抬高组术后3d、7d比较,ST段抬高组术后颈总动脉瘤血管内径明显变小[3d:(0.29±0.05)cm比(0.18±0.01)cm,7d:(0.39±0.03)cm比(0.19±0.03)cm,P<0.01],瘤样扩张血管远近端血流速度明显增大[V_远:3d:(0.52±0.01)m/s比(0.71±0.02)m/s,7d:(0.56±0.02)m/s比(0.79±0.09)m/s;V_近:3d:(0.59±0.07)m/s比(0.78±0.06)m/s,7d:(0.68±0.07)m/s比(0.89±0.09)m/s,P均<0.01]。术后与ST段无抬高组比较,ST段抬高组左室射血分数明显降低,左室舒张末期内径明显增大,cTnI水平明显升高(P<0.05或<0.01)。结论:CCA动脉瘤存在颈总动脉、冠状动脉血管痉挛,冠脉血管痉挛是动脉瘤心肌损伤的主要机制。Objective：To explore pathological neural mechanisms of common carotid artery（CCA）aneurysm complicated myocardial injury and its relationship with vasospasm.Methods：CCA aneurysm model,usually reflecting intracranial aneunysm,was established in 60 Japanese big ear rabbits according to improved pancreatic elastase inducement method.According to presence of elevated ST segment on ECG after operation,rabbits were divided into ST elevation group（n=25）and no ST elevation group（n=21）.Meanwhile,echocardiography was performed,level of cardiac troponin I（cTnI）etc.was measured to assess myocardial injury status.After operation,vascular ultrasound was performed to dynamically measure CCA aneurysm vasodilation diameter and local blood flow velocity so as to assess the relationship between vasospasm and CCA aneurysm complicated myocardial injury.Results：Compared with 1 dand 5d,there was significant reduction in vascular diameter of CCA aneurysm,and significant rise in proximal and distal blood flow velocity on 3d after operation in ST elevation group,and recovered then,aneurysm vascular diameter significantly reduced and blood flow velocity significantly rose again on 7d after operation（P〈0.05or0.01）.Compared with no ST elevation group on 3d and 7d,there were significant reductions in CCA aneurysm vascular diameter[3d：（0.29±0.05）cm vs.（0.18±0.01）cm,7d：（0.39±0.03）cm vs.（0.19±0.03）cm,P〈0.01]and significant rise in CCA aneurysm vascular proximal and distal blood flow velocity[V_（distal）：3d：（0.52±0.01）m/s vs.（0.71±0.02）m/s,7d：（0.56±0.02）m/s vs.（0.79±0.09）m/s;V_（proximal）：3d：（0.59±0.07）m/s vs.（0.78±0.06）m/s,7d：（0.68±0.07）m/s vs.（0.89±0.09）m/s,P〈0.01all]in ST elevation group.Compared with no ST elevation group after operation,there was significant reduction in LVEF,significant rise in LVEDd and cTnI level in ST elevation group,P〈0.05.Conclusion：There exist CCA and coronary vasospasm in CCA aneurysm,and coronary vaso

关 键 词：动脉瘤 心肌 冠状血管痉挛 

分 类 号：R543.160.9[医药卫生—心血管疾病]