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中国临床药理学与治疗学 ›› 2003, Vol. 8 ›› Issue (2): 149-154.

• 研究原著 • 上一篇    下一篇

急性心肌缺血激光心肌血管重建术与碱性成纤维生长因子联合应用对心脏功能及心肌存活性影响的实验研究1

谢明星, 王新房, 朱向明, 杨娅, 吕清, 陈立新, 聂绍平2, 蒋桔泉2, 曹林生2   

  1. 华中科技大学同济医学院附属协和医院超声影像科, 2心内科, 武汉 430022, 湖北
  • 收稿日期:2002-10-22 接受日期:2003-01-23 出版日期:2003-04-26 发布日期:2020-11-25
  • 通讯作者: WANG Xin-Fang.
  • 作者简介:XIEMing-Ming, male, MD, vice-professor, engaged in cardiovascular ultrasonography.Tel:027-85726430 E-mail:Xiemingxing<xmxxyj@publ
  • 基金资助:
    National Laser Stressed Laboratory, Huazhong University of Science and Technology (№200017)

Effects of transmyocardial laser revascularization combined with basic fibroblast growth factor on myocardial viability and cardiac function in dog models with acute myocardial ischemia1

XIE Ming-Ming, WANG Xin-Fang, ZHU Xiang-Ming, YANG Ya, LU Qing, CHEN Li-Xin, NIE Shao-Ping2, JIANG Jue-Quan2, CAO Lin-Shen2   

  1. Department of Ultrasonography, 2Institute of Cardiovascular Disease, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei
  • Received:2002-10-22 Accepted:2003-01-23 Online:2003-04-26 Published:2020-11-25

摘要: 目的: 评价急性心肌缺血激光心肌血管重建术(TMLR) 与碱性成纤维生长因子纤维蛋白胶(bFGF-FG) 联合应用对缺血心肌存活性及心脏局部和整体功能的影响。方法: 18 只健康杂种犬随机分为3 组, 即急性心肌缺血组(AMI 组)、激光打孔组(TMLR组) 和碱性成纤维生长因子组(bFGF-FG 组)。所在实验犬均结扎冠状动脉左前降支, 建立急性心肌缺血模型。结扎后30 minTMLR 组和bFGF-FG 组行激光心肌打孔, bFGF-FG 组于打孔后即刻将碱性成纤维生长因子纤维蛋白胶埋植入心肌激光隧道。15只犬在冠脉结扎后2 mon 进行了常规及脉冲组织多普勒多巴酚丁胺负荷超声心动图检查。另外3 只犬(每组1 只) 分别于术后42、56 和60 d 死亡。结果: 左房室腔径3 组之间无明显差异(P >0.05)。左室局部及整体功能参数TMLR 组和bFGF-FG 组较AMI组改善, 部分指标的组间差异有显著性(P <0.05或P <0.01)。AMI 组静脉输注小剂量多巴酚丁胺后,左室功能参数恶化, 部分指标的变化有显著性意义(P <0.05或P <0.01)。TMLR 组按5 μg ·kg-1 ·min-1静脉输注多巴酚丁胺后, 左室功能参数改善,剂量增大到10 μg·kg-1 ·min-1, 上述功能参数呈现相反的变化趋势。bFGF-FG 组按5 μg·kg-1·min-1静脉输注多巴酚丁胺后, 左室功能参数改善, 剂量增大到10 μg·kg-1 ·min-1, 上述功能参数基本维持在5 μg·kg-1 ·min-1时的水平(P >0.05)。结论: TMLR 能够改善急性心肌缺血的灌注, 与bFGF-FG 联合应用加强心肌灌注的改善, 以维持缺血心肌的存活性, 阻止心脏局部及整体功能的进一步损害。

关键词: 缺血性心脏病, 激光心肌血管重建术, 碱性成纤维生长因子, 心肌存活性, 心室功能, 超声心动描记术

Abstract: AIM: To assess the effects of transmyocardial laser revascularization (TMLR) combined with basic fibroblast growth factor-fibrin glue (bFGF-FG) on the myocardial viability and the cardiac regional and global function in dog models with acute myocardial ischemia (AMI). METHODS: Eighteen crossbred dogs were randomized to three groups.(AMI, TMLR and bFGF-FG groups).The occlusion of the left anterior descending artery (LAD) of all animals was created in order to develop acute ischemic myocardium models.TMLR procedure was carried out 30minutes after coronary ligation in both TMLR and bFGF-FG groups, and afterward bFGF-FG was planted in laser channels in bFGF-FG group.15 dogs underwent conventional and pulsed Doppler tissue imaging dobutamine stress echocardiography two months after LAD occlusion (other 3 dogs for each group died 42, 56 and 60 days after operation, respectively). RESULTS: There was no difference in the diameter of left atrium and ventricle among three groups (P >0.05).The regional and globe function parameters of the left ventricle improved in the TMLR and bFGF-FG groups gradually by turns, compared to the AMI group, of which there were significant differences in some variables among three groups (P <0.05 or P <0.01).In AMI group, the parameters above worsened during dobutamine infusion, of which some changed significantly (P <0.05 or P < 0.01).In TMLR group, the parameters improved during dobutamine infusion in 5 μg·kg -1·min -1, of which some changed significantly (P <0.05 or P <0.01), while they changed in reverse direction during dobutamine infusion in 10 μg·kg -1·min -1.In bFGF-FG group, the parameters improved during dobutamine infusion in 5 μg · kg -1 ·min -1, of which some changed significantly (P < 0.05 or P <0.01).There were no significant differences in all variables above during dobutamine infusion in 10 μg ·kg -1·min -1 in comparison with in 5 μg·kg -1·min -1 (P >0.05). CONCLUSION: TMLR can improve the perfusion of acute ischemic myocardium, and TMLR combined with bFGF-FG can enhance improvement of myocardial perfusion to maintain the viability of ischemic myocardium and prevent the cardiac regional and global function from advancing impairment in acute myocardial ischemia.

Key words: ischemic heart disease, transmyocardial laser revascularization, basic fibroblast growth factor, myocardial viability, ventricular function, echocardiography

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