瑞芬太尼后处理对大鼠心肌缺血-再灌注损伤的影响  

Effects of remifentanil postconditioning after myocardial ischemia reperfusion in rats

作　　者：郑宏[1] 林鹏焘[2] 陈文华[2] 王兰兰[3] 李丽珍[4] 

机构地区：[1]解放军福州总医院麻醉科,350000 [2]福建医科大学附属协和医院麻醉科 [3]福建省肿瘤医院麻醉科 [4]福建省人民医院麻醉科

出　　处：《临床麻醉学杂志》2017年第8期785-788,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨瑞芬太尼后处理对缺血-再灌注心肌的影响及其机制。方法清洁级健康雄性SD大鼠78只,体重200~250g,随机分为六组:假手术组(S组)、单纯缺血-再灌注组(IR组)、纳洛酮拮抗剂组(NAL组)、瑞芬太尼5μg·kg^(-1)·min^(-1)后处理组(R1组)、瑞芬太尼10μg·kg^(-1)·min^(-1)后处理组(R2组)和瑞芬太尼20μg·kg^(-1)·min^(-1)后处理组(R3组),每组13只。S组仅在冠状动脉左前降支处穿线,但不结扎;IR组结扎冠状动脉左前降支,缺血45 min,再灌注24h;R1、R2和R3组在缺血35min时,分别静脉输注瑞芬太尼5、10和20μg·kg^(-1)·min^(-1),10min后再灌注24h;NAL组在心肌缺血25min时,静脉注射纳洛酮0.1mg·kg^(-1),10min后静脉输注瑞芬太尼10μg·kg^(-1)·min^(-1),10min后再灌注24h。观察心肌梗死面积和心肌病理学变化,同时测定血清肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肌酸激酶同工酶MB(CK-MB)的浓度。结果与S组比较,IR、NAL、R1、R2和R3组血清cTnI、LDH、CK-MB浓度明显升高,心肌梗死面积百分比明显增大(P<0.05),心肌细胞损伤增多;与IR组比较,R1、R2和R3组血清cTnI、LDH、CK-MB浓度明显降低,心肌梗死面积百分比明显减小(P<0.05),心肌细胞损伤减少(P<0.05)。结论瑞芬太尼后处理可减轻大鼠心肌缺血-再灌注损伤,其机制与瑞芬太尼激活阿片受体有关,此作用具有量效"封顶"效应。Objective To explore the effect of remifentanil postconditioning on rats subjected to ischemia reperfusion injury and the relative mechanisms.Methods Seventy-eight Sprague-Dawley rats,weighing 200-250 g,were randomly divided into six groups（n=13）：sham group（group S）,ischemia/reperfusion group（group IR）,naloxone group（group NAL）,5μg·kg^-1·min^-1remifentanil postconditioning group（group R1）,10μg·kg^-1·min^-1remifentanil postconditioning group（group R2）and 20μg·kg^-1·min^-1remifentanil postconditioning group（group R3）.Group IR was given 45 min ischemia in the left descending anterior（LAD）,followed by a 24-h period of reperfusion.Groups R1,R2,R3 received 10min of remifentanil infusion of 5,10 and 20μg·kg^-1·min^-1fter 35 min ischemia followed by a 24 hperiod of reperfusion.Group NAL was given injection of naloxone 0.1 mg/kg at the point of 25 min myocardial ischemia,after 10 min,then remifentanil 10μg·kg^-1·min^-1for 10 min.The myocardial infarct size and pathological changes of myocardial tissue were observed,serum cTnI,LDH and CK-MB level were measured.Results Compared with group S,serum cTnI,LDH and CK-MB and myocardial infarct size were markedly increased in groups IR,NAL,R1,R2 and R3（P0.05）,and pathologic injury of myocardial cells were augmented.In comparison with group IR,the indexes were decreased in groups R1,R2 and R3（P〈0.05）.Conclusion Remifentanil postconditioning could protect against myocardial ischemia reperfusion injury in rats.The protection may be related to remifentanil activating the opioid receptors.There were ceiling effects of remifentanil postconditioning induced myocardial protection.

关 键 词：瑞芬太尼 后处理 大鼠 心肌缺血-再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]