缺血后适应干预对急性心肌梗死再灌注后心肌无复流面积的影响

目的探讨缺血后适应干预对急性心肌梗死再灌注后心肌无复流面积的影响。方法新西兰大白兔30只随机分为3组：对照（Sham）组、手术（R/I）组和缺血后适应（IPC）组,每组各10只,制备AMI再灌注和缺血后适应的模型。采用心肌病理染色确定缺血区、无复流区及梗死区面积;分别于结扎冠脉前5min、1h末及再灌注2h末,于颈动脉采血,采用酶联免疫吸附法（ELISA）检测血清中肌钙蛋白I（cTnI）的水平。结果 IPC组的无复流范围及梗死范围明显小于R/I组,差异具有统计学意义（P〈0.05）。结扎前5min各组血清中cTnI水平差异无统计学意义（P〉0.05）;结扎1h末及再灌注2h末R/I组、IPC组与Sham组比较,差异均有统计学意义（P〈0.05）;在结扎1h末IPC组与R/I组比较,差异无统计学意义（P〉0.05）;而在再灌注2h末IPC组与R/I组比较,差异有统计学意义（P〈0.05）。结论缺血后适应可以减轻AMI再灌注后无复流的发生,缩小心肌梗死面积,更好地改善患者的心功能。

The influence of adapting to the intervention of acute myocardial infarction after ischemia reperfusion of myocardial no reflow area

Objective To investigate the effects of postconditioning on Myocardial no-reflow size after AM1 reperfusion in rabbits models. Methods Thirty rabbits were randomly divided into 3 groups：10 in control （Sham） group,10 in surgery group （R/I} and 10 in ischemic postconditioning group {IPC） and taken as the AMI reperfusion and postconditioning models. We take carotid blood samples separately 5mins before coronary artery ligation, lhr after coronary artery ligation and 2 hrs after reperfu sion to monitor the cTnI level in serum by the method of ELISA, using cardiac pathology staining to measure the ischemic area, no-reflow zone and infarct area. Results The no-reflow area and infarct area of IPC group was significantly smaller than the range of R/I,the difference was statistically significant （P＇〈0.05 ）. eTnI levels in blood taken 5 mins before ligation in each group showed no significant difference （P〉0.05） ;the cTnI level in the blood taken 1 hr after ligation and 2 hrs after reperfu- sion showed statistically significant difference in R/I group and IPC group compared with Sham group （P〈0.05）; 1 hr after ligation between IPC group and R/I group showed no statistically significant difference（P〉0.05） ;while 2 hrs after reperfusion the difference between IPC group and R/I group was statistically significant （P〈0.05）. Conclusion Ischemic postconditioning can reduce the incidence of no reflow after AMI reperfusion,decrease the myocardial infarct size and improve the level of hemo- dynamics.