经导管急性微血管栓塞对冠状动脉血流和冠状动脉血流储备的影响  

The effect of acute microembolization on coronary blood flow and coronary flow reserve

作　　者：张良惠 钱菊英 张庆勇 蔡乃绳 罗忠池[2] 汪源源[2] 王威琪[2] 葛均波 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所200032 [2]上海复旦大学电子工程系

出　　处：《中国介入心脏病学杂志》2003年第3期117-119,共3页Chinese Journal of Interventional Cardiology

基　　金：复旦大学Med X基金;上海市重点发展基金资助。

摘　　要：目的　建立经导管的急性微血管栓塞动物模型 ,研究不同微栓塞水平冠状动脉血流(CBF)和冠状动脉血流储备 (CFR)的变化。方法　 10头小型猪 (2 1～ 2 5kg) ,不开胸经导管由前降支重复注入微栓塞球 (4 5 μm) ,使用多普勒导丝、压力导丝和腔内超声导管测量前降支中段平均流速、压力和腔内面积 ,CBF =平均流速×面积。冠状动脉内注射腺苷 18μg达到最大充血状态 ,CFR =充血CBF 基础CBF。在微栓塞前、注入 5万、10万、12万、14万和 15万微栓塞球时分别测量基础状态和充血状态的血流动力学指标。结果　注入 5万微球时基础CBF(rCBF)升高 ,较微栓塞前差异有显著性[(0 30± 0 0 9)ml·s- 1 vs (0 2 6± 0 10 )ml·s- 1 ,P <0 0 5 ],随着微球量的增加rCBF降低。CFR在微栓塞后降低 ,不同微栓塞水平的CFR与微栓塞前比较差异均有显著性。结论　经导管急性微血管栓塞中 ,随着微栓塞球量增加 ,rCBF呈现先增加后下降的双期改变 ;微栓塞后CFR下降 ,CFR在一定微栓塞程度时又有增加。Objective To investigate the effect of acute microembolization on coronary blood flow (CBF) and coronary flow reserve (CFR) in pig models by use of catheterization techniques. Methods The left anterior descending coronary artery (LAD) of 10 pigs (21-25 kg) were embolized by repetitive injections of 45 μm microspheres. Coronary average flow velocity, pressure and lumen area were measured using Doppler flow wire, pressure wire and intracoronary ultrasound imaging catheter in the middle segment of LAD. CBF was calculated from the equation of flow velocity times lumen area. Intracoronary bolus injection of adenosine was used to induce maximal coronary hyperemic reaction. CFR was defined as the ratio of hyperemic CBF to resting CBF.Results Significant differences were found regarding the resting CBF and CFR at different levels of microembolization. Resting CBF increased significantly under injection of 5×10 4 microspheres [(0.30±0.09) ml·s -1 vs (0.26±0.10) ml·s -1 in pre-microembolization, P<0.05]. Thereafter, resting CBF decreased as the dosage of microspheres increased. CFR decreased significantly at different levels of microembolization. Conclusion Resting CBF presented a biphasic pattern in the presence of microembolization. Accordingly, CFR decreased significantly when microembolization occurred.

关 键 词：经导管急性微血管栓塞 动物模型 冠状动脉血流 冠状动脉血流储备 缺血性心脏病 

分 类 号：R654.2[医药卫生—外科学]