重组人B 型钠尿肽对急性心肌梗死伴心力衰竭模型心肌耗氧量的影响

【摘要】目的 评估不同剂量重组人B 型钠尿肽（rhBNP）对急性心肌梗死伴心力衰竭（AMI-HF）模型心肌耗氧量的影响。方法 应用前降支球囊闭塞结合微血栓悬液灌注构建约克猪AMI-HF 模型，随机分为rhBNP 组和对照组。rhBNP 组给予rhBNP1.5 μg·kg-1，2 min 内匀速静推后，以0.01、0.02、0.03 μg·kg-1·min-1 依次分别静脉泵入60 min。对照组给予等容积生理盐水。在球囊闭塞前、成模后即刻（T1）、不同剂量rhBNP 给药后60 min（T2~T4）同步抽取冠脉内和冠状静脉窦血标本，评估心肌耗氧量（MOU）。行定量冠脉造影测量冠脉直径的变化。应用Swan-Ganz 漂浮导管同步监测血流动力学变化。结果 与对照组相比，rhBNP 组肺毛细血管楔压（PCWP）、中心静脉压（CVP）、心率（HR）、收缩压（SBP）和MOU 在给药后明显下降，而心排血量（CO）和冠脉直径在给药后增加。药物干预与时间存在交互效应。rhBNP 组MOU 较成模后即刻显著降低T1~T4 分别为（11.59±0.37）、（10.61±0.35）、（9.85±0.60）、（9.79±0.31）mL O2/L]。结论 AMI-HF 模型静脉内应用rhBNP，可以在降低PCWP、升高CO 的同时，降低MOU。

Effects of Recombinant Human B-type Natriuretic Peptid on Oxygen Consumption in Acute Myocardial Infarction with Heart Failure

Abstract] Objective To evaluate the impact of different doses of recombinant human B-type natriuretic peptid (rhBNP) within the dosage of clinical rage on oxygen consumption during acute myocardial infarction (AMI) with heart failure (HF). Methods AMI-HF model of York pig was established by occluding coronary artery with balloon combined with injecting microthrombus. Then animals were randomized into rhBNP group and control group. Clinical dose of rhBNP (1.5 μg kg bolus followed by a continuous infusion with speed of 0.01, 0.02 and 0.03 μg·kg-1·min-1 for 60 minutes respectively in turn) was administrated in rhBNP group while equal volume of saline was given in the control group. Myocardial oxygen uptake (MOU) was measured by drawing blood from coronary artery and coronary sinus using a catheter. Coronary diameter was determined using quantitative coronary angiography. The observation points were at baseline (T0), instant after the model establishment (T1), 60 min after continuous rhBNP infusion of 0.01, 0.02, 0.03 μg·kg-1·min-1 (T2-T4) respectively. Results Compared with the control group, pulmonary capillary wedge pressure, central venous pressure, heart rate, systolic blood pressure and MOU were significantly decreased after rhBNP administration. And cardiac output and coronary diameter were obviously increased with addition of rhBNP. There is a interaction of drug intervention and time. In rhBNP group, MOU was significantly decreased with drug administraion (T2-T4 vs T1，mL O2/L: 10.61±0.35，9.85±0.60，9.79±0.31 vs 11.59±0.37). Conclusion Intravenous administration of rhBNP in AMI-HF model could decrease MOU and PCWP while increase the cardiac output.