应用Albunex 结合经胸多普勒超声评估无复流时冠脉血流速度模式变化的实验研究

中国临床药理学与治疗学 ›› 2005, Vol. 10 ›› Issue (3): 270-275.

应用Albunex 结合经胸多普勒超声评估无复流时冠脉血流速度模式变化的实验研究

陈立新, 王新房¹, 谢明星¹, 朱向明², 吴瑛

暨南大学医学院第二附属医院, 深圳市人民医院超声科, 深圳518020, 广东;
¹华中科技大学同济医学院协和医院超声科, 武汉430022, 湖北;
²皖南医学院弋矶山医院超声科, 芜湖241001, 安徽

收稿日期:2005-01-11 修回日期:2005-02-15 出版日期:2005-03-26 发布日期:2020-11-18

Assessment of coronary flow velocity pattern during no-reflow phenomenon by transthoracic Doppler echocardiography combined with administration of Albunex

CHEN Li-xin, WANG Xin-fang¹, XIE Ming-xing¹, ZHU Xiang-ming², WU Ying

Department of Ultrasonography, Shenzhen People's Hospital & the Second Affiliated Hospital of Medical School of Jinan University, Shenzhen 518020, Guangdong, China;
¹Department of Ultrasonography, Union Hospital of Tongji Medical School, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China;
²Department of Ultrasonography, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China

Received:2005-01-11 Revised:2005-02-15 Online:2005-03-26 Published:2020-11-18
Contact: CHEN Li-xin, male, MD, engaged in the medical ultrasound in cardiology.Tel:0755-25533018-3351 E-mail:neost ar84@yahoo.com.cn

摘要/Abstract

摘要： 目的:应用Albunex 进行心肌声学造影结合经胸多普勒冠脉血流显像观察犬急性心肌缺血再灌注时梗死相关动脉(IRA) 血流灌注模式的变化, 探讨该变化与心肌微血管损害之间的关系。方法:健康杂种犬19 只, 均结扎左前降支(LAD) 60 min, 而后分别再灌注60 min (n=6), 120 min (n=6) 和180 min(n=7)。LAD 结扎后经静脉弹丸式注射Albunex进行MCE 检查, MCE 显示的低灌注区为危险区(RA_MCE), 再灌注后MCE 检查确定的低灌注区为无复流区(NRA_MCE)。若NRA_MCE/RA_MCE 比值大于或等于25% 时认为发生了无复流现象;若NRA_MCE/RA_MCE比值小于25% 时认为心肌复流。多普勒超声使用冠脉血流程序检测IRA 血流动力学各项指标。结果:2 只犬在实验中死亡, 其余17 只犬均完成实验方案。复流组共有7 支犬, 无复流组共有10 支犬。再灌注60 min 时, PVs, VTIs, cFDs, PVd, VTId,cFDd, DDR, cDDD 在复流组有所变化, 但与基础状态相比较差异无显著意义(P 值均>0.05);而无复流组的PVs, VTIs, cFDs, PVd, VTId, cFDd 均明显减小(P 值均<0.05), 舒张期最显著的变化是减速度(DDR) 明显增大(P<0.01), 减速时间(DDD) 显著减小(P<0.01)。结论:微血管床的损害可以影响心外膜冠脉血流动力学。这种变化可能主要是通过增加微血管阻力, 降低冠脉灌注压的途径来实现的。经胸多普勒超声结合Albunex 注射进行心肌声学造影可以无创性评估无复流时梗死相关动脉血流速度模式变化。

关键词: 多普勒, 超声心动图, 梗死相关动脉, 无复流, Albunex

Abstract: AIM: To validate the alternations of flow velocity patterns in the infarct-related artery (IRA) during no-reflow phenomenon in a canine model of acute myocardial ischemia and reperfusion by transthoracic Doppler echocardiography (TTDE) combined with myocardial contrast echocardiography (MCE) by means of administration of Albunex.METHODS: Nineteen dogs first underwent 60 min myocardial ischemia and then followed by 60 min, 120 min and 180 min reperfusion (n=6, 6 and 7, respectively).The perfusion defect area determined by MCE at 60 min myocardial ischemia was regarded as risk area (RA_MCE).The perfusion defect area defined by MCE after reperfusion was considered as no-reflow area (NRA_MCE).The ratio between NRA_MCE and RA_MCE ≥25% was regarded as the development of no-reflow phenomenon and the ratio of NRA_MCE to RA_MCE <25% was considered as the myocardial reflow.The coronary flow velocity parameters in IRA were determined through TTDE.RESULTS: Two dogs died during experiment and the remaining seventeen dogs completed throughout the procedure. There were seven dogs in reflow group and ten dogs in noreflow group.No significant difference was present in reflow group between at baseline and at 60 min reperfusion in systolic peak velocity (PVs), systolic velocity time integral (VTIs), corrected systolic flow duration (cFDs), diastolic peak velocity (PVd), diastolic velocity time integral (VTId), corrected diastolic flow duration (cFDd), diastolic deceleration rate (DDR), corrected diastolic deceleration duration (cDDD) (P>0.05), however, a significant difference was found in no-reflow group between at baseline and at 60 min reperfusion in PVs, VTIs, cFDs, PVd, VTId and cFDd (P<0.05).The most marked alterations during diastolic phase were the increase of DDR and reduction of cDDD.CONCLUSION: The impaired microvasculature may profoundly affect the coronary flow velocity pattern in the IRA.The increase in microvascular resistance and decrease in coronary perfused pressure can contribute to the changes. Transthoracic Doppler echocardiography combined with MCE has the capability of noninvasive assessment of coronary flow velocity pattern in the IRA during no-reflow phenomenon.

Key words: Doppler, echocardiography, infarct-related artery, no-reflow, Albunex

中图分类号:

陈立新, 王新房, 谢明星, 朱向明, 吴瑛. 应用Albunex 结合经胸多普勒超声评估无复流时冠脉血流速度模式变化的实验研究[J]. 中国临床药理学与治疗学, 2005, 10(3): 270-275.

CHEN Li-xin, WANG Xin-fang, XIE Ming-xing, ZHU Xiang-ming, WU Ying. Assessment of coronary flow velocity pattern during no-reflow phenomenon by transthoracic Doppler echocardiography combined with administration of Albunex[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2005, 10(3): 270-275.

参考文献

1 Schofer J, Mont R, Mathey DG.Scintigraphic evidence of the “no reflow” phenomenon in human beings after coronary thrombolysis[J].J Am Coll Cardiol, 1985;5:593-8
2 Bates ER, Krell MJ, Dean EN, O'Neill WW, Vogel RA. Demonstration of the “ no-reflow” phenomenon by digital coronary arteriography[J].Am J Cardiol, 1986;57:177-8
3 Nicklas JM, Diltz EA, O'Neill WW, Bourdillon PDV, Walton JA Jr, Pitt B.Quantitative measurement of coronary flow during medical revascularization (thrombolysis or angioplasty) in patients with acute infarction[J].J Am Coll Cardiol, 1987;10: 284-9
4 Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, et al.Lack of myocardial perfusion immediately after successful thromboly sis:a predictor of poor recovery of left ventricular function in anterior myocardial infarction [J].Circulation, 1992;85:1699-705
5 Ragosta M, Camarano G, Kaul S, Powers ER, Sarembock ER, Gimple LW.Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction:new insights using myocardial contrast echocardiography [J].Circulation, 1994;89:2562-9
6 Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, et al.Incidence and treatment of‘no-reflow'after percutaneous coronary intervention[J].Circulation, 1994;89:2514-8
7 Shani J, Feld H, Frankel R, Hollander G.Reversal of the noreflow phenomenon with intracoronary verapamil during coronary angioplasty for acute myocardial infarction[J].Circulation, 1992;86:I-852
8 Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al.Myocardial perfusion patterns related to Thrombolysis In Myocardial Infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction [J].Circulation, 1996;93:1993-9
9 Kloner RA, Ganote CE, Jennings RB.The “ no-reflow” phenomenon after temporary coronary occlusion in the dog[J].J Clin Invest, 1974;54:1496-508
10 Reffelmann T, Hale SL, Li GH, Kloner RA.Relationship between no re flow and infarct size as influenced by the duration of ischemia and reperfusion[J].Am J Physiol Heart Circ Physiol, 2002;282:H766-72
11 Reffelmann T, Kloner RA.Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit[J].Am J Physiol Heart Circ Physiol, 2002;283: H1099-107
12 Nicklas JM, Diltz EA, O'Neill WW, Bourdillon PD, Walton JA Jr, Pitt B.Quantitative measurement of coronary flow during medical revascularization (thromboly sis or angioplasty) in patients with acute infarction[J].J Am Coll Cardiol, 1987;10: 284-9
13 Engler RL, Schmid-Schoenbein G, Pavelec SR.Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog[J].Am J Pathol, 1983;111:98-111
14 Frame LH, Powell WJ Jr.Progressive perfusion impairment during prolonged in myocardial ischemia in canine myocardium [J].Circ Res, 1976;39:269-76
15 Gorman MW, Sparks HVJ.Progressive coronary vasoconstriction during relative ischemia in dogs[J].Circ Res, 1982;51: 411-20
16 Iwakura K, Ito H, Takiuchi S, Taniyama Y, Nakatsuchi Y, Negoro S, et al.Alteration in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction[J].Circulation, 1996;94:1269-75
17 Eleuteri E, Scapellato F, Temporelli PL, Giannuzzi P.Evaluation of the left anterior descending artery flow velocity by transthoracic echo-Doppler without contrast enhancement[J].Ital Heart J, 2002;3:520-4
18 Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, et al.Coronary flow velocity analysis during short term follow up after coronary reperfusion:use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction[J].Heart, 2003;89:1163-8

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