CAJ | 학술논문

目的对比观察芬太尼后处理、远隔缺血后处理和缺血后处理3种干预措施抑制大鼠心肌缺血/再灌注初期室性心律失常作用的差别.方法将73只成年雄性SD大鼠(体重250 g～350 g)麻醉后按随机数字表法随机分为9组:空白对照组(S组,n=5)；对照组(C组,n=7)；芬太尼后处理组(F组,n=9)；肢体远隔缺血后处理组(R组,n=9)；缺血后处理组(P组,n=8)；联合应用芬太尼后处理和肢体远隔缺血后处理组(F-R组,n=9)；联合应用芬太尼后处理和缺血后处理组(F-P组,n=8)；联合应用肢体远隔缺血后处理和缺血后处理组(R-P组,n=9)；联合应用芬太尼后处理、肢体远隔缺血后处理和缺血后处理组(F-R-P组,n=9).所有大鼠开胸后采用丝线套扎其冠状动脉左前降支(left anterior descending coronary artery,LAD)做成活结.除S组之外,所有大鼠接受局部心肌缺血30 min和再灌注60 min的处理.C组不采用任何干预措施；F组、F-R组、F-P组和F-R-P组在LAD结扎15 min时缓慢静脉注射芬太尼30 μg/kg;R组、F-R组、R-P组和F-R-P组在LAD结扎15 min时结扎大鼠双下肢造成肢体缺血10 min后恢复双下肢血流灌注；P组、F-P组、R-P组和F-R-P组开放实施再灌注的初期连续实施3个循环的开放LAD 20 s/阻断LAD 20 s的缺血后处理.记录缺血期和再灌期前30 min内的心律失常评分(AS评分)以及室性心动过速(ventricular tachycardia,VT)和心室纤颤(ventricular fibrillation,VF)的发生率和持续时间.结果缺血期VT和VF的发生率、VT或VF的持续时间以及AS评分在C组、F组、R组、P组、F-R组、F-P组、R-P组和F-R-P组无统计学差异.C组、F组、R组、P组、F-R组、F-P组、R-P组和F-R-P组再灌注初期AS评分的中位数分别为4、2、2、1、2、1、1和2.与C组比较,其余各组再灌注初期室性心律失常发生显著减少；再灌注初期的VT持续时间和AS在F组和R组之间无统计学差异,但F-R组再灌注初期的VT持续时间则显著降低.与F组和R组比较,P组、F-R组、F-P组、R-P组和F-R-P组再灌注初期的VT持续时间和室性心律失常评分显著减低. 结论与芬太尼后处理和远隔缺血后处理比较,缺血后处理可更有效抑制再灌注初期室性心律失常的发生.联合应用芬太尼后处理和远隔缺血后处理后,抑制心肌再灌注初期室性心律失常的作用相对增强. 目的對比觀察芬太尼後處理、遠隔缺血後處理和缺血後處理3種榦預措施抑製大鼠心肌缺血/再灌註初期室性心律失常作用的差彆.方法將73隻成年雄性SD大鼠(體重250 g～350 g)痳醉後按隨機數字錶法隨機分為9組:空白對照組(S組,n=5)；對照組(C組,n=7)；芬太尼後處理組(F組,n=9)；肢體遠隔缺血後處理組(R組,n=9)；缺血後處理組(P組,n=8)；聯閤應用芬太尼後處理和肢體遠隔缺血後處理組(F-R組,n=9)；聯閤應用芬太尼後處理和缺血後處理組(F-P組,n=8)；聯閤應用肢體遠隔缺血後處理和缺血後處理組(R-P組,n=9)；聯閤應用芬太尼後處理、肢體遠隔缺血後處理和缺血後處理組(F-R-P組,n=9).所有大鼠開胸後採用絲線套扎其冠狀動脈左前降支(left anterior descending coronary artery,LAD)做成活結.除S組之外,所有大鼠接受跼部心肌缺血30 min和再灌註60 min的處理.C組不採用任何榦預措施；F組、F-R組、F-P組和F-R-P組在LAD結扎15 min時緩慢靜脈註射芬太尼30 μg/kg;R組、F-R組、R-P組和F-R-P組在LAD結扎15 min時結扎大鼠雙下肢造成肢體缺血10 min後恢複雙下肢血流灌註；P組、F-P組、R-P組和F-R-P組開放實施再灌註的初期連續實施3箇循環的開放LAD 20 s/阻斷LAD 20 s的缺血後處理.記錄缺血期和再灌期前30 min內的心律失常評分(AS評分)以及室性心動過速(ventricular tachycardia,VT)和心室纖顫(ventricular fibrillation,VF)的髮生率和持續時間.結果缺血期VT和VF的髮生率、VT或VF的持續時間以及AS評分在C組、F組、R組、P組、F-R組、F-P組、R-P組和F-R-P組無統計學差異.C組、F組、R組、P組、F-R組、F-P組、R-P組和F-R-P組再灌註初期AS評分的中位數分彆為4、2、2、1、2、1、1和2.與C組比較,其餘各組再灌註初期室性心律失常髮生顯著減少；再灌註初期的VT持續時間和AS在F組和R組之間無統計學差異,但F-R組再灌註初期的VT持續時間則顯著降低.與F組和R組比較,P組、F-R組、F-P組、R-P組和F-R-P組再灌註初期的VT持續時間和室性心律失常評分顯著減低. 結論與芬太尼後處理和遠隔缺血後處理比較,缺血後處理可更有效抑製再灌註初期室性心律失常的髮生.聯閤應用芬太尼後處理和遠隔缺血後處理後,抑製心肌再灌註初期室性心律失常的作用相對增彊.
목적 대비관찰분태니후처리、원격결혈후처리화결혈후처리3충간예조시억제대서심기결혈/재관주초기실성심률실상작용적차별.방법 장73지성년웅성SD대서(체중250 g～350 g)마취후안수궤수자표법수궤분위9조:공백대조조(S조,n=5)；대조조(C조,n=7)；분태니후처리조(F조,n=9)；지체원격결혈후처리조(R조,n=9)；결혈후처리조(P조,n=8)；연합응용분태니후처리화지체원격결혈후처리조(F-R조,n=9)；연합응용분태니후처리화결혈후처리조(F-P조,n=8)；연합응용지체원격결혈후처리화결혈후처리조(R-P조,n=9)；연합응용분태니후처리、지체원격결혈후처리화결혈후처리조(F-R-P조,n=9).소유대서개흉후채용사선투찰기관상동맥좌전강지(left anterior descending coronary artery,LAD)주성활결.제S조지외,소유대서접수국부심기결혈30 min화재관주60 min적처리.C조불채용임하간예조시；F조、F-R조、F-P조화F-R-P조재LAD결찰15 min시완만정맥주사분태니30 μg/kg;R조、F-R조、R-P조화F-R-P조재LAD결찰15 min시결찰대서쌍하지조성지체결혈10 min후회복쌍하지혈류관주；P조、F-P조、R-P조화F-R-P조개방실시재관주적초기련속실시3개순배적개방LAD 20 s/조단LAD 20 s적결혈후처리.기록결혈기화재관기전30 min내적심률실상평분(AS평분)이급실성심동과속(ventricular tachycardia,VT)화심실섬전(ventricular fibrillation,VF)적발생솔화지속시간.결과 결혈기VT화VF적발생솔、VT혹VF적지속시간이급AS평분재C조、F조、R조、P조、F-R조、F-P조、R-P조화F-R-P조무통계학차이.C조、F조、R조、P조、F-R조、F-P조、R-P조화F-R-P조재관주초기AS평분적중위수분별위4、2、2、1、2、1、1화2.여C조비교,기여각조재관주초기실성심률실상발생현저감소；재관주초기적VT지속시간화AS재F조화R조지간무통계학차이,단F-R조재관주초기적VT지속시간칙현저강저.여F조화R조비교,P조、F-R조、F-P조、R-P조화F-R-P조재관주초기적VT지속시간화실성심률실상평분현저감저. 결론 여분태니후처리화원격결혈후처리비교,결혈후처리가경유효억제재관주초기실성심률실상적발생.연합응용분태니후처리화원격결혈후처리후,억제심기재관주초기실성심률실상적작용상대증강.
Objective To investigate the effects of fentanyl postconditioning,remote ischemia postconditioning and ischemia postconditoning on ventricular arrhythmias during myocardial ischemia and initial reperfusion in rats. Methods Seventy-three anesthetized male SD rats (weighed 250 g to 350 g) were randomly allocated into nine groups:sham group (group S,n=5),control group (group C,n=7),fentanyl postconditioning group (group F,n=9); remote postconditioning group (group R,n=9),ischemia postconditioning group (group P,n=8); combined fentanyl postconditioning and remote postconditioning group (group F-R,n=9);combined fentanyl postconditioning and ischemia postconditioning group (group F-P,n=8); combined remote postconditioning and ischemia postconditioning group (group R-P,n=9); and combined all three methods group (group F-R-P,n=9).Thoracotomy was performed in the rats,and the left anterior descending coronary artery (LAD) was encircled with a suture to make a snare.Except for the group S,in the other groups,LAD was ligated for 30 min (ischemia) followed by a 60 min reperfusion (LAD open) in vivo.In group C,no additional intervention was performed.In groups F,F-R,F-P and F-R-P,fentanyl 30 μg/kg was slowly injected intravenously at 15 min after LAD ligation.In groups R,F-R,R-P and F-R-P,the bilateral hind limbs underwent a 10 min ischemia which started at 15 min after LAD ligation with tourniquet.In groups P,F-P,R-P and F-R-P,30 min after LAD ligation,Ischemia postconditioning was done with successive three cycles of a 20 s LAD open followed by a 20 s LAD re-occlusion.During the periods of ischemia and the first 30 min of reperfusion,the arrhythmias score (AS),the incidences and durations of ventricular tachycardia (VT) and fibrillation (VF) were recorded.Results There were no significant differences in the AS,incidences and durations of VT and VF during the periods of ischemia among groups C,F,R,P,F-R,F-P,R-P and F-R-P.The medians of AS during initial period of reperfusion in groups C,F,R,P,F-R,F-P,R-P and F-R-P were 4,2,2,1,2,1,1 and 2 respectively.During initial period of reperfusion,compared with group C,incidence of ventricular arrhythmia was significantly decreased in other groups; duration of both VT and AS did not significantly changed in groups F and R,but duration of VT was shorter in group F-R.As compared to groups F,R and F-R,duration of VT during initial period of reperfusion was significantly shorter,and AS was lower in groups P,F-P,R-P and F-R-P.Conclusions As compared with fentanyl postconditioning and remote postconditioning,ischemia postconditioning was more effective in anti-arrhythmia during initial period of reperfusion.Combined fentanyl postconditioning and remote postconditioning can produce an enhanced anti-arrhythmic effect during the myocardial ischemia-reperfusion process.