CAJ | 학술논문

背景:大量研究表明透室壁性心肌血管重建能有效治疗难治性心绞痛和终末期冠心病,但心肌血运重建后透室壁性心肌孔道不能保持长时间通畅,容易闭合,从而限制了该技术的应用.目的:认识高压喷射心肌打孔联合孔道内填充温敏型壳聚糖水凝胶对孔道的影响,以及该治疗方法对急性心肌梗死犬的血管新生及心肌的保护作用.方法:将Injex无针注射器经适当改造后制作成高压喷射系统;由壳聚糖盐酸盐、β-甘油磷酸钠和羟基乙基纤维素按照一定的浓度比配制成温敏型壳聚糖水凝胶.健康杂种犬24只随机均分为3组:①单纯心肌梗死组制模成功后直接关胸.②心肌打孔+水凝胶组将壳聚糖水凝胶于结扎线以下左室前壁行高压喷射透壁性心肌打孔8～10个(1孔/cm~2).③心肌打孔组用等体积生理盐水于相同部位行心肌打孔.6周后行血流动力学检测,计算微血管密度和心肌梗死面积,行苏木精-伊红染色观察孔道通畅情况,天狼猩红染色检测胶原增生情况并计算I、III型胶原比值.结果与结论:①术后6周,心肌打孔组孔道明显缩小,部分节段已完全闭塞;心肌打孔+水凝胶组孔道仍未闭塞,开放直径100～300 μm,部分节段已内皮化.②与单纯心肌梗死组比较,心肌打孔组和心肌打孔+水凝胶组促进了梗死区血管新生,且心肌打孔+水凝胶组缩小了梗死面积,在一定程度上改善了左室重塑.提示高压喷射心肌打孔联合孔道内温敏型壳聚糖水凝胶填充有助于保持孔道的通畅,能促进孔道周围血管新生,缩小梗死面积,具有改善左室重塑的作用,是治疗心肌梗死的一种可行的方法.
배경:대량연구표명투실벽성심기혈관중건능유효치료난치성심교통화종말기관심병,단심기혈운중건후투실벽성심기공도불능보지장시간통창,용역폐합,종이한제료해기술적응용.목적:인식고압분사심기타공연합공도내전충온민형각취당수응효대공도적영향,이급해치료방법대급성심기경사견적혈관신생급심기적보호작용.방법:장Injex무침주사기경괄당개조후제작성고압분사계통;유각취당염산염、β-감유린산납화간기을기섬유소안조일정적농도비배제성온민형각취당수응효.건강잡충견24지수궤균분위3조:①단순심기경사조제모성공후직접관흉.②심기타공+수응효조장각취당수응효우결찰선이하좌실전벽행고압분사투벽성심기타공8～10개(1공/cm~2).③심기타공조용등체적생리염수우상동부위행심기타공.6주후행혈류동역학검측,계산미혈관밀도화심기경사면적,행소목정-이홍염색관찰공도통창정황,천랑성홍염색검측효원증생정황병계산I、III형효원비치.결과여결론:①술후6주,심기타공조공도명현축소,부분절단이완전폐새;심기타공+수응효조공도잉미폐새,개방직경100～300 μm,부분절단이내피화.②여단순심기경사조비교,심기타공조화심기타공+수응효조촉진료경사구혈관신생,차심기타공+수응효조축소료경사면적,재일정정도상개선료좌실중소.제시고압분사심기타공연합공도내온민형각취당수응효전충유조우보지공도적통창,능촉진공도주위혈관신생,축소경사면적,구유개선좌실중소적작용,시치료심기경사적일충가행적방법.
BACKGROUND: Many experiments have suggested that transmyocardial revascularization (TMR) is effective in refractory angina pectoris and end-stage coronary artery disease. The main problem for TMR, however, is occlusion of the transmural channels, which limits the application of the technology.OBJECTIVE: To explore the impact of transmyocardial high-pressure injection revascularization combined with thermo-sensitive chitosan hydrogel filled the channels on channel's patency and the effect of promoting angiogenesis and myocardial protection on acute myocardial infarction.METHODS: High-pressure injection system, Injex needle-free syringe was made by the appropriate transformation of post-production. Thermo-sensitive chitosan hydrogel was made of chitosan hydrochloride, β-glycerol phosphate and hydroxyethyl cellulose prepared in accordance with a certain concentration ratio. A total of 24 healthy hybrid dogs were randomly assigned to three groups. In the simple myocardial infarction group (SMI), acute myocardital infarction models were made by ligation of the left anterior descending coronary artery. No treatment was given in SMI group. In the transmyocardial high-pressure injection revascularization group (TMIR) with thermo-sensitive chitosan hydrogel group (TMIR+chitosan), transmyocardial high-pressure injection revascularization was performed on infarct myocardium and about 8 to 10 transmural channels were created in ischemic area, one channel per square centimeter. In the TMIR group, the same volume saline was used in the identical site. Hemodynamics, capillary density and myocardial infarct size were detected at 6 weeks after treatment. Hematoxylin and eosin staining and Sinus red staining were used to detect channel patency and collagenous fiber proliferation, and the ratio of type I, III collagen was calculated.RESULTS AND CONCLUSION: The channels in TMIR group had significantly narrowed; some segments had been completely occluded. However, channels in TMIR + chitosan group had not been occluded, the opening diameter was about 100-300 um; some segments had been endothelialization. Compared with the SMI group, TMIR group and TMIR + chitosan group promoted angiogenesis in the infarct area, and TMIR + chitosan group reduced the infarct size and improved left ventricular remodeling. These indicated that transmyocardial high-pressure injection revascularization combined with thermo-sensitive chitosan hydrogel filled the channels is helpful to maintain the channel patency and can promote angiogenesis around the channels, reduce infarct size and improve left ventricular remodeling. It may be a viable approach in the treatment of myocardial infarction.