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远端器官缺血性预处理对心血管功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2001年第5期
页码:
363-365,368
栏目:
论著
出版日期:
2001-09-01

文章信息/Info

Title:
The effects of remote organ ischemic preconditioning on cardiovascular function
作者:
夏正远1;  Takahiro NISHIDA2; Willem FLAMENG2
1. 湖北医科大学附属第一医院麻醉科, 湖北武汉430060;2. 比利时鲁汶大学(K. U. Leuven) 实验外科与麻醉学中心
Author(s):
XIA Zheng-yuan1;  Takahiro NISHIDA2; Willem FLAMENG2
1. Department of Anesthesiology, First Affiliated Hospital of Hubei Medical University,Wuhan Hubei 430060, China; 2. Center for Experimental Surgery and Anesthesiology, K. U. Leuven,Belgium
关键词:
远端器官;  缺血性预处理;  股动脉;  心血管功能
Keywords:
remote organ;  ischemic preconditioning;  iliac artery;  cardiovascular function
分类号:
R331. 3
DOI:
-
文献标识码:
A
摘要:
目的 观察远端器官缺血性预处理(RPC) 对非缺血心脏功能的影响, 初步探讨RPC 的作用机制。方法 19 只成年绵羊麻醉后随机分为对照组(n= 9) 及RPC 组(n= 10)。测定基础状态(BS1) 各参数后, RPC 组动物经历3 次左侧股动脉阻断5 min 及再灌注5 min, 第三次再灌注后10 min 测RPC 后(BS2) 各参数。对照组动物不阻断股动脉,但于相应时间测定BS1 及BS2 各参数。结果 对照组BS1 及BS2 各参数无显著变化。RPC 显著降低平均动脉压(MAP)、外周血管阻力(SVR) 及冠脉循环阻力(CVR) (P < 0. 05) ; 轻度增加心排出量及冠脉血流量(P > 0. 05)。但RPC 对心率、左房压、每搏输出量、射血分数及每搏作功无显著影响。BS2 时RPC 组左室收缩末期压(LVESP)、左室压力上升及下降最大速率(±dp/dtmax)、动脉有效弹回性(Effective arterial elastance, Ea) 均显著低于对照组(P < 0. 05) , 而心脏收缩及舒张期左室容积下降及增加最大速率(±dv/dtmax) 无显著变化。结论 远端器官缺血性预处理降低动脉有效弹性及循环阻力、减弱心脏收缩性的同时, 并不减弱反而轻度增强心脏泵血功能, 提高了心肌收缩效率。
Abstract:
AIM To invest igate the effects of remote organischemic preconditioning (RPC) on the functions of non-ischemic heart. METHODS 19 adult sheep were randomly divided into control group (n= 9) and RPC group (n= 10) after anesthesia. After the measurement of the baseline parameters (BS1) in the two groups, RPC was achieved by 3 episodes of 5min occlusion and 5min reperfusion of the left iliacartery. Animals in control group did not receive iliac artery occlusion.Parameters after RPC (BS2 ) were measured at 10 min following the last time iliac artery reperfusion. RESULTS There is not significant changes in all parameters of control group. RPC significantly reduced mean artery pressure (MAP ) , systemic vascular resistance (SVR ) and coronary vascular resistance (CVR, P < 0.05) and slightly increased cardiac output (CO ) and coronary blood flow (CBF ). At BS2, left ventricular end-systolic pressure (LVESP) ,maximum and minimum of the first derivative of left ventricular pressure ( ± dp/dtmax ) as well as the effective arterial elastance (Ea ) in RPC group were significantly lower than those in control group. However, RPC did not significantly alter heart rate, left atrium pressure, stoke volume,ejection fraction, stroke work,maximum and minimum of first derivative of left ventricular volume( ±dv/dtmax ). CONCLUSION Heart pretreated by PRC may have better cardiac function and lower energy cost which might be related to the reduced afterload. Therefore, RPC may have potential benefits in at tenuating myocardium ischemia/reperfusion injury.

参考文献/References

[1] Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium[J]. Circulation, 1986, 74 (5) : 1124.

[2] Przyklenk K, Bauer B, Ovize M , et al. Regional ischemic‘preconditioning ’ protects remote virgin myocardium from subsequent sustained coronary occlusion [J]. Circulation, 1993,87 (3) : 893.

[3] Xia ZY, Herijgers P,Wouters P, et al. Remote preconditioning improves lung function after repeated coronary artery occlusion and reperfusion [C]. Annual Scientific Meeting in Anesthesiology, Hong Kong: Programme Book, 1999. 48.

[4] Sunagawa K, Sagawa K. Models of ventricular contraction based on time-varying elastance [J]. Crit Rev Biomed Eng , 1982, 7(3) : 193.

[5] Gho BC, Schoemaker RG, van den Doel MA , et al. Myocardial protection by brief ischemia in noncardiac tissue [J].Circulation, 1996, 94 (9): 2193.

备注/Memo

备注/Memo:
收稿日期：2000-06-12.
更新日期/Last Update: 2001-09-01