CAJ | 학술논문

目的观察右美托咪定预处理对猪心肌缺血再灌注损伤的保护作用.方法小型猪20头,体质量25 ～ 35 kg,雌雄不限.随机分为两组:右美托咪定预处理组(Dex组)、对照组(C组),每组10头.肌肉注射氯胺酮及咪达唑仑麻醉后,行气管切开,机械控制通气,七氟烷维持麻醉.Dex组同时静脉注射负荷量右美托咪定0.5μg/kg,随后持续泵入0.5μg/(kg·h)维持至冠状动脉阻断前,对照组注射等容量生理盐水.开胸暴露心脏后,于冠状动脉前降支中下1/3处阻断30 min,再灌注时间为60 min.阻断前后不同时间点记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP).分别于开胸前、阻断后30 min、再灌注后30、60 min抽取颈内静脉血4ml,酶联免疫吸附法测定猪血清心肌肌钙蛋白I (cTnI)、肌酸激酶心肌型同工酶(CK-MB)浓度.心肌缺血再灌注20 min进行心律失常评分.再灌注结束后,重新阻断冠状动脉前降支,伊文氏蓝染色,计算心肌梗死面积(IS％).结果再灌注30 min和再灌注60 min时C组的CK-MB及cTnI高于D组(P＜0.05).C组和D组再灌注20 min心律失常评分分别为(3.300 ±0.675)和(2.000 ±0.677)分,组间比较差异有统计学意义(P＜0.05).C组的IS％(42.4％)高于D组(23.5％,P＜0.05).结论 Dex预处理可减轻猪心肌缺血再灌注损伤,具有心肌保护作用.
목적 관찰우미탁미정예처리대저심기결혈재관주손상적보호작용.방법 소형저20두,체질량25 ～ 35 kg,자웅불한.수궤분위량조:우미탁미정예처리조(Dex조)、대조조(C조),매조10두.기육주사록알동급미체서륜마취후,행기관절개,궤계공제통기,칠불완유지마취.Dex조동시정맥주사부하량우미탁미정0.5μg/kg,수후지속빙입0.5μg/(kg·h)유지지관상동맥조단전,대조조주사등용량생리염수.개흉폭로심장후,우관상동맥전강지중하1/3처조단30 min,재관주시간위60 min.조단전후불동시간점기록평균동맥압(MAP)、심솔(HR)、중심정맥압(CVP).분별우개흉전、조단후30 min、재관주후30、60 min추취경내정맥혈4ml,매련면역흡부법측정저혈청심기기개단백I (cTnI)、기산격매심기형동공매(CK-MB)농도.심기결혈재관주20 min진행심률실상평분.재관주결속후,중신조단관상동맥전강지,이문씨람염색,계산심기경사면적(IS％).결과 재관주30 min화재관주60 min시C조적CK-MB급cTnI고우D조(P＜0.05).C조화D조재관주20 min심률실상평분분별위(3.300 ±0.675)화(2.000 ±0.677)분,조간비교차이유통계학의의(P＜0.05).C조적IS％(42.4％)고우D조(23.5％,P＜0.05).결론 Dex예처리가감경저심기결혈재관주손상,구유심기보호작용.
Objective To investigate the effects of dexmedetomidine preconditioning on myocardial ischemia-reperfusion injury in pigs.Methods Twenty healthy pigs of both sexes,weighing 25-35 kg,were randomly divided into two groups (n =10 each):control group (group C),and dexmedetomidine group (Dex group).Ketamine 10 mg/kg combined with midazolam 0.1 mg/kg were injected intramuscularly,and the trachea was intubated after the incision of trachea followed by mechanical ventilation.Anesthesia was maintained with sevoflurane (1.5％-2.0％).A loading dose of dexmedetomidine 0.5 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg/(kg·h) until the occlusion of descending coronary artery.After the infusion of study drugs,the hearts were subject to 30 min of regional ischemia followed by 60 min of reperfusion.Mean arterial pressure (MAP),heart rate (HR),and central venous pressure (CVP) were recorded at the time point of pre-ischemia,10 and 30 min after ischemia,and 10,30 and 60 min after reperfusion.The blood samples from the internal jugular vein were collected,cTnI and CK-MB were determined by enzyme linked immunosorbent assay (ELISA).The arrhythmia was scored 20 min after the reperfusion.The descending coronary artery was reoccluded after the end of reperfusion,and the left ventricles which were not blocked were stained with Evans blue.The left ventricles were sliced from base to the tip into 10-mm slices.The infarct size (IS％) was calculated.Results CK-MB and cTnI were higher in group C than in Dex group at re-perfusion 30 min and 60 min (P ＜ 0.05).The scores of the arrhythmia were (3.300 ±0.675) in group C,higer than in Dex group (2.000 ±0.677) (P ＜ 0.05).IS％ in group C was 42.4％,higher than in Dex group (23.5％,P ＜0.05).Conclusion Dexmedetomidine preconditioning can reduce myocardial ischemia-reperfusion injury in pigs.