停灌与再灌注时间对心肌缺血再灌注损伤程度的影响研究  

Effect of Suspension Time and Reperfusion Time on Myocardial Ischemia-reperfusion Injury

作　　者：杨天睿[1] 苗云波[1] 张彤[1] 段靳岚 朱滢[1] 穆宁晖 余锦雯 YANG Tian-rui;MIAO Yun-bo;ZHANG Tong;DUAN Jin-lan;ZHU Ying;MU Ning-hui;YU Jin-wen(Department of Geriatrics,the First People's Hospital of Yunnan Province,Kunming 650032,China)

机构地区：[1]云南省第一人民医院老年病科,云南省昆明市650032

出　　处：《中国全科医学》2018年第11期1310-1314,共5页Chinese General Practice

基　　金：云南省内设研究机构老年病防治研究中心立项课题(2016NS203);云南省卫计委医学后备人才培养计划(H-201615);云南省应用基础研究[昆医联合专项;2017FE468(-112)];云南省应用基础研究[昆医联合专项;2017FE467(-109)]

摘　　要：目的探讨停灌时间、再灌注时间对心肌缺血再灌注损伤程度的影响,为防止缺血再灌注损伤的发生或减轻其损伤程度提供依据。方法 2015年9月—2017年5月,选取健康成年雄性实验树鼩,采用随机数字表法分为5组,保证每组采用Langendorff离体心脏灌注系统成功建立心肌缺血再灌注损伤模型10只。A组稳定灌注30 min后取5只实验树鼩观察心肌梗死面积,其余继续灌注直至90 min。B组稳定灌注30 min,停灌15 min,再灌注30 min。C组稳定灌注30 min,停灌15 min,再灌注60 min。D组稳定灌注30 min,停灌30 min,再灌注30 min。E组稳定灌注30 min,停灌30 min,再灌注60 min。B^E组分别在停灌后取5只实验树鼩观察心肌梗死面积,其余继续再灌注。灌注结束,沿心脏冠状面切片,计算梗死面积。取灌注液、心肌组织,检测丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)水平。结果 A组、D组、E组停灌与再灌注后实验树鼩心肌梗死面积比较,差异无统计学意义(P>0.05);B组、C组再灌注后实验树鼩心肌梗死面积较停灌后增加(P<0.05)。B^E组再灌注后心肌梗死面积大于A组,D、E组心肌梗死面积大于B、C组(P<0.05)。双因素方差分析显示,停灌时间对灌注液、心肌组织的ALT、AST,以及对灌注液CK-MB、LDH的主效应显著,而再灌注时间对灌注液、心肌组织的ALT、AST、CK-MB、LDH的主效应均显著(P<0.05)。结论缺血时间和再灌注时间是影响心肌缺血再灌注损伤程度的关键因素,其中以再灌注时间更为重要。Objective To investigate the effect of suspension time and perfusion time on myocardial ischemiareperfusion injury,in order to provide experimental evidence for the prevention or reduction of ischemia-reperfusion injury.Methods This study was conducted between September 2015 and May 2017.Healthy adult male tree shrews were divided into five groups by random number table,and there were 10 tree shrews in each group,which were successfully established myocardial ischemia-reperfusion injury models through Langendorff technique.Treatment in group A was stable perfusion for 30 min,and 5 tree shrews were uesd to observed infarction areas,and the others were continue perfusing for 60 min.In group B,treatment included stable perfusion for 30 min,suspension for 15 min and reperfusion for 30 min;in group C,treatment was stable perfusion for 30 min,suspension for 15 min and reperfusion for 60 min.In group D,stable perfusion,suspension and reperfusion were undertaken for 30,30 and 30 min,respectively;in group E,stable perfusion,suspension and reperfusion were undertaken for 30,30 and 60 min,respectively.In B-E groups,5 tree shrews were uesd to observed infarction areas after suspension,and the others were continue reperfusing.The infarction area was calculated based on heart coronal sections.Perfusion fluid and myocardial tissues were obtained to determine the levels of alanine aminotransferase(ALT),aspartate transaminase(AST),creatine kinase-MB(CK-MB)and lactate dehydrogenase(LDH).Results There was no statistically significant difference in myocardial infarction area between suspension and reperfusion in group A,D and E(P>0.05).The myocardial infarction area were increased after reperfusion than that after suspension in group B and C(P<0.05).The infarction areas in group B-E were significantly larger than that in group A,and group D and E had a larger infarction area than group B and C(P<0.05).Two-factor analysis of variance showed that the main effect of suspension time was significant for the ALT and AST level in perfusion

关 键 词：心肌再灌注损伤 停灌时间 再灌注时间 

分 类 号：R542.2[医药卫生—心血管疾病]