远隔缺血后处理对猪心肌急性缺血/再灌注损伤的保护作用

摘要

Aim: To investigate the cardioprotective effects of hindlimb remote ischaemic postconditioning in a pig model of acute myocardial ischaemic-reperfusion injury(IRI). Methods: All pigs were randomly divided into two groups; control and remote group. All the ten pigs were subjected to a total of 30 min of left anterior descending coronary artery ( LAD) occlusion and 6 h of reperfusion. Remote group underwent ischaemic postconditioning was induced by four S min cycles of double femoral artery occlusion and release immediately after the coronary artery reperfusion. Throughout the experiment, fH, MAP, CO, LAD blood flow(LADF) and ECG were continuously monitored. Plasma level of cTnT was measured at baseline, the end of ischaemia, and after 3,6 h of reperfusion respectively. Infarct size was assessed by area under the curve for total cTnT release. Results: The results showed no significant differences between two groups in parameters of haemodynamics( FfH = 1. 777,P =0. 219;FMAP = 1. 118 ,P =0. 321; FLADF = 0. 838,P = 0. 387;FCO = 0. 320,P = 0. 587 ) and the difference of ventricular arrhythmic score during the periol of ischemia and reperfusion ( t = 0. 548 , P = 0. 599 ) . Compared to control group,infarct size was reduced by 29. 5% in remote group. Plasma cTnT level in remote group decreased significantly compared with control group ( Fgroup =6.213, Ftime = 173. 657 , Fgroup x time = 5. 900, P < 0. 05 ). Conclusion : Hindlimb remote ischaemic postconditioning is a simple, safe and valuable technique to reduce myocardial ischemia-reperfusion injury.%目的:探讨下肢远隔缺血后处理对猪心肌急性缺血/再灌注损伤的保护作用.方法:将10头猪随机分为对照组(C组)和处理组(R组)2组,每组5头.2组都接受冠状动脉左前降支闭塞30 min然后再灌注6 h的处理.R组在冠状动脉开始再灌注的同时对双侧股动脉实施4次缺血5 min再灌注5 min的远隔缺血后处理.实验过程中,连续监测猪的心率(fH)、平均动脉压(MAP)、心输出量(CO)、冠状动脉左前降支血流(LADF)和心电图(对室性心律失常进行评分).分别在缺血开始前后和再灌注后3和6 h获取血浆标本,用于检测肌钙蛋白(cTnT).利用cTnT总释放量曲线下面积量化评估心肌梗死面积.结果:2组间的血流动力学指标比较差异均无统计学意义(Ffh=1.777,P=0.219;FMAP=1.118,P=0.321;FLADF=0.838,P=0.387;Fco=0.320,P=0.587);2组间缺血期和再灌注期室性心律失常评分差值比较,差异无统计学意义(t=0.548,P=0.599).与C组相比R组的心肌梗死面积减少29.5%;R组血浆cTnT水平较C组下降(F组间=6.213,F组间=173.657,F交互=5.900.P均<0.05).结论:下肢远隔缺血后处理是一种简单、安全和有效地减轻心肌缺血/再灌注损伤的方法.