冠状动脉阻抗参数对微栓塞后冠状动脉微循环功能的评价  

Coronary resistance system in evaluation of microvascular dysfunction after intracoronary microembolization:an experimental study

作　　者：张良惠[1] 葛均波[1] 钱菊英[1] 张庆勇[1] 罗忠池[2] 汪源源[2] 蔡逎绳 王威琪[2] 

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]复旦大学电子工程系

出　　处：《中华医学杂志》2004年第7期578-582,共5页National Medical Journal of China

基　　金：复旦大学Med-X重点培育基金项目资助 ;上海市医学重点发展基金项目资助 (2 0 0 0IZD0 0 2 )

摘　　要：目的　研究冠状动脉阻抗参数对微栓塞后冠状动脉微循环功能的评价。方法　 10头小型猪不开胸经导管重复性注入前降支微栓塞球 (45 μm) ,通过多普勒导丝、压力导丝和腔内超声导管与心电同步分别在微栓塞前及不同微栓塞程度采集前降支中段基础状态和最大充血状态的多普勒信号、压力信号以及腔内超声图像 ,通过自制软件建立了反映冠脉脉动流阻抗的冠脉阻抗参数。结果　因子分析发现一次谐波基础冠脉阻抗和一次谐波最小冠脉阻抗分别与基础状态和最大充血状态冠脉阻抗参数中提取出的第一主成分相关性最好 (r分别为 0 913和 0 95 0 )。最小冠脉阻抗在少量微栓塞 (5万个 )无明显变化 ,随着微球量的增加逐渐增加 ,自 10万个微球开始最小冠脉阻抗较微栓塞前 (2 6 7mmHg·ml-1·s-1± 10 6mmHg·ml-1·s-1)均明显增加 (P <0 0 5 ) ,10万到 15万个微球时最小冠脉阻抗无明显变化。一次谐波最小冠脉阻抗在少量微栓塞球 (5万个 )时无明显变化 ,随着微栓塞球量的增加逐渐增加 ,自 14万个微球开始一次谐波最小冠脉阻抗较微栓塞前明显增加 (P <0 0 5 )。结论　一次谐波冠脉阻抗比平均冠脉阻抗更能代表不同微栓塞程度时冠脉阻抗参数的变化 ,微血管功能障碍程度与微栓塞程度不成正比。Objective To assess the microvascular function of coronary artery after intracoronary microembolization using coronary resistance system. Methods The left anterior descending coronary artery (LAD) of 10 pigs weighing 21 kg-25 kg were embolized by repetitive injection of microspheres 45 μm in diameter through a 2.8F Tracker catheter. Intra-vascular ultrasound (IVUS) images, intracoronary Doppler and pressure signals in the middle segment of LAD were acquired by use of intracoronary ultrasound imaging catheter, Doppler flow wire and pressure wire separately. Intracoronary bolus injection of 18 μg adenosine was administered to maximally vasodilate the coronary arterial bed through the 2.8F Tracker catheter. The resting and hyperemic signals were acquired respectively before microembolization and in different levels of microembolization. Coronary resistance system reflecting the resistance to pulsatile coronary flow was established by a self-made software of PC system. The resting and hyperemic CR parameters included average resting coronary resistance (rCR) and average minimal coronary resistance (min-CR), the first-harmonic rCR and min-CR, the first-harmonic rCR orientation and min-CR orientation, and so on. Factor analysis was performed to extract the best coronary parameter from the coronary resistance parameters. Results Factor analysis showed that the first-harmonic rCR and first-harmonic min-CR were correlated better with the first component extracted from the resting and hyperemic CR parameters than rCR and min-CR, with the correlation coefficient being 0.913 and 0.950 in the first-harmonic CR and first-harmonic min-CR respectively. No significant difference in min-CR was found between the value at the dosage of 5×10 4 microspheres and that before microembolization. The min-CR value increased markedly from 271 mm Hg·ml -1 ·s -1 ±99 mm Hg·ml -1 ·s -1 at the dosage of injecting 5×10 4 microspheres to 361 mm Hg·ml -1 ·s -1 ±158 mm Hg·ml -1 ·s -1 at the dosage of injecting

关 键 词：冠状动脉阻抗参数 冠状动脉 微循环 腔内超声图像 微血管功能障碍 

分 类 号：R541.4[医药卫生—心血管疾病]