高压喷射心肌打孔及孔道内填充温敏型壳聚糖水凝胶对孔道的影响

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/cm2)。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100~300μm,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...

Transmyocardial high-pressure injection revascularization combined with thermo-sensitive chitosan hydrogel effects on channels

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 a...