主动灌注与分流栓在猪急性心肌缺血模型中心肌保护作用比较  

Comparison of protective effects of active perfusion and shunt perfusion on ischemic myocardial

作　　者：封赞祥[1] 侯芳[1] 刘宝辉[1] 李伟[1] 王锋[1] 钱兆洋[1] 王玉玖[1] 

机构地区：[1]滨州医学院附属医院心脏外科,滨州256603

出　　处：《滨州医学院学报》2017年第4期244-248,共5页Journal of Binzhou Medical University

基　　金：山东省医药卫生科技发展计划(2015WS0480)

摘　　要：目的建立猪急性心肌缺血模型,并对比主动灌注法与分流栓(shunt)法对缺血心肌的保护作用。方法将30只体重在50~60kg的雄性猪随机分为5组:对照组、A1(shunt-55%狭窄)组、A2(shunt-75%狭窄)组、B1(主动灌注-55%狭窄)组、B2(主动灌注-75%狭窄)组,(n=6)。手术组缝扎前降支近端部分管腔,分别建立55%、75%冠脉狭窄模型后,检测主动脉压(P_0)力与狭窄后冠脉灌注压(P_1),计算出冠脉有效灌注压(P_1/P_0);Elisa法检测各组血浆中肿瘤坏死因子-α(TNF-α)、肌钙蛋白I(cTnⅠ)、肌红蛋白(Mb)、肌酸激酶-同I酶(CK-MB)、白介素-6(IL-6)、白介素-10(IL-10)的含量。结果冠状动脉前降支血管部分缝扎法成功建立了冠状动脉狭窄55%、75%的心肌缺血模型。模型建立成功30min(或ST段抬高1mm)后,与对照组相比,手术狭窄组的有效灌注压(P_1/P_0)均显著下降(P<0.01),TNF-α、cTnⅠ、Mb、CK-MB、IL-6、IL-10显著上升(P<0.01)。与A组相比,B组的有效灌注压(P_1/P_0)显著增加(P<0.01),TNF-α、cTnⅠ、Mb、CK-MB、IL-6、IL-10显著降低(P<0.01),提示B组心肌损伤程度低于A组。结论与传统的shunt法相比,主动灌注法可以更好的维持心肌灌注压力,提高心肌保护效果。Objective To establish the porcine myocardial ischemia model, compare and estimate the protective effects of active perfusion and shunt perfusion on ischemic myocardiaLMethods The acute myocardial ischemia was induced by suturing left anterior descending coronary artery at the proximal in 24 anesthetized,open-chest pigs. Thirty pigs were randomly divided into five groups ： natural control group （ N）, shunt-55% coronary artery stenosis group （ A1 ）, shunt-75 % coronary artery stenosis group （A2）,active perfusion -55% coronary artery stenosis group （B1）, and active perfusion -75% coronary artery stenosis group（B2 ）. Aortic pressure（P0 ） ,left anterior descending coronary pressure（P1 ）, and the effective coronary artery pressure ratio （ P0/P1 ） were measured 30mins after myocardial ischemia. The expression levels of TNF-a,cTnI, Mb,CK-MB, IL-6, and IL- 10 were observed with Elisa,respectively. Results After operation, compared with those in the control group, left anterior descending coronary pressure（P% ） ,and the effective coronary artery pressure ratio （P0/P1 ） in other groups significantly decreased （P〈0.01） and TNF-α,cTnI, Mb, CK-MB, IL-6, and IL-10 in other groups significantly increased （P〈0.01）. On the other hand, compared with those in group A, P1 and P1/P0 in group B significantly increased （ P〈0.01 ）, and TNF-α, cTnI, Mb,CK- MB,IL-6,and IL-10 in group B significantly decreased （P〈0. 01 ）, showing that the degree of myocardial ischemia in B group was lower than that in group A. Conclusion Compared with shunt perfusion,active perfusion appears, to have a more protective effect on ischemic myocardial.

关 键 词：急性心肌损伤 动物模型 主动灌注 分流栓灌注 

分 类 号：R542.2[医药卫生—心血管疾病]