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目的评价尼可地尔防治猪急性心肌梗死(AMI)再灌注后无再流的作用。方法中华小型猪24只,随机分成对照组、尼可地尔组和假手术组,每组8只。结扎冠状动脉(冠脉)3h、松解1h制备AMI再灌注模型。AMI前后和再灌注后均行血流动力学测定和心肌声学造影(MCE)检查,最终行病理学分析。结果1与AMI前相比,对照组AMI后3h左室收缩压(LVSP)、心排血量(CO)和左室内压最大收缩和舒张变化速率(±dp/dtmax)均显著下降(P<0.05或P<0.01),左室舒张末压(LVEDP)显著升高(P<0.01);再灌注后1h仅LVSP显著恢复(P<0.05),±dp/dtmax继续显著下降(P均<0.05)。尼可地尔组AMI后3h各项指标变化与对照组相同;但再灌注后1hLVSP、LVEDP、±dp/dtmax和CO均恢复,差异有显著性(P<0.05),且比对照组更显著(P均<0.05)。2对照组MCE和病理染色所测冠脉结扎区心肌范围(LA%)高度一致(P>0.05),再灌注后无再流范围(ANR%)分别为(78.50±4.35)%和(82.30±1.90)%,心肌坏死范围(NA%)为(98.50±1.35)%。尼可地尔组LA%虽与对照组相当(P均>0.05),但两方法所测ANR%和NA%均显著小于对照组(P<0.05或P<0.01)。3对照组再灌注即刻和再灌注后1h冠脉血流量(CBV)仅占AMI前的50.6%和45.8%(P均<0.01);尼可地尔组CBV分别提高到69.4%和67.9%,均比对照组显著增加(P均<0.01)。结论尼可地尔能有效防治AMI再灌注后无再流,改善其心功能,缩小梗死面积。
Objective To evaluate the effect of no-reflow after nicorandil against porcine acute myocardial infarction (AMI) reperfusion. Methods Twenty-four Chinese miniature pigs were randomly divided into control group, nicorandil group and sham operation group, with 8 rats in each group. Ligation of coronary artery (coronary artery) 3h, release 1h preparation AMI reperfusion model. The hemodynamics and myocardial contrast echocardiography (MCE) were performed before and after AMI and after reperfusion, and finally pathological analysis was performed. Results 1 Compared with before AMI, the left ventricular systolic pressure (LVSP), cardiac output (CO), left ventricular pressure maximum systolic and diastolic velocity (± dp / dtmax) decreased significantly at 3h after AMI in control group (P < (P <0.05 or P <0.01), left ventricular end diastolic pressure (LVEDP) increased significantly (P <0.01), only LVSP recovered significantly at 1 hour after reperfusion (P0.05), ± dp / ). The indexes of 3 hours after AMI in Nicorandil group were the same as those in control group, but the levels of VSP, LVEDP, ± dp / dtmax and CO were all restored at 1 hour after reperfusion, the difference was significant (P <0.05) (P <0.05). (2) The myocardial area (LA%) of coronary artery ligation zone measured by MCE and pathological staining in the control group were highly consistent (P> 0.05). The ANR% of the control group was 78.50 ± 4.35% and 82.30 ± 1.90%), and the range of myocardial necrosis (NA%) was (98.50 ± 1.35)%. The LA% in nicorandil group was comparable to that in the control group (P> 0.05), but the ANR% and NA% of the two methods were significantly lower than those of the control group (P <0.05 or P <0.01). The CBV of control group was only 50.6% and 45.8% respectively (P <0.01) immediately after reperfusion and 1h after reperfusion; the CBV in nicorandil group increased to 69.4% and 67.9% respectively, Both significantly increased compared with the control group (all P <0.01). Conclusion Nicorandil can effectively prevent and treat AMI after reperfusion without reflow, improve its cardiac function and reduce infarct size.