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远端器官缺血性预处理 (RPC)可减少缺血再灌注后心肌坏死范围。本研究旨在观察RPC对缺血再灌注心脏不同部位血流及心律失常发生率的影响。方法 :19头成年绵羊随机分为对照组 (n =9)及RPC组 (n =10 )。RPC组动物接受 3次左侧股动脉阻断 (5min)及再灌注 (5min) ,随后两组动物均分别依次阻断左冠状动脉前降支 (LAD) 10min ,再灌注 10min ;左冠状动脉第一分支 (D1)阻断及再灌注 10min后阻断左旋支 (LCX) 10min ,再灌注后观察 12 0min。结果 :LCX再灌注 10min时RPC组左室心内膜前壁、间隔及心外膜间隔心肌血流量 (分别为 0 .86± 0 .2 7,1.10±0 .34及 1.2 0± 0 .5 1ml·min-1·g-1)显著高于对照组 (分别为 0 .6 4± 0 .2 8,0 .6 9± 0 .2 3及 0 .5 8± 0 .2 6ml·min-1·g-1) ,P <0 .0 5。RPC显著减少再灌注后心室纤颤的发生率 (对照组 8/ 9,RPC组 2 / 10 ,P <0 .0 1)。冠状动脉阻断及再灌注后对照组主动脉平均压低于RPC组 ,但差异无显著性 (P >0 .0 5 )。结论 :RPC显著减少心肌缺血及再灌注期心室纤颤的发生 ,其机制可能与RPC显著改善心内膜血液供应有关。
Distal Ischemic Preconditioning (RPC) Decreases the Range of Myocardial Necrosis after Ischemia-Reperfusion. The purpose of this study was to investigate the effect of RPC on the incidence of blood flow and arrhythmia in different parts of the heart following ischemia-reperfusion. Methods: Nineteen adult sheep were randomly divided into control group (n = 9) and RPC group (n = 10). The animals in the RPC group were subjected to occlusion of the left femoral artery (5 min) and reperfusion (5 min) three times, then the left anterior descending artery (LAD) was occluded for 10 min and reperfused for 10 min in each group. The left coronary artery A branch (D1) blocked and reperfusion 10min after blocking the left spinous process (LCX) 10min, reperfusion after 120min. Results: The myocardial blood flow in the anterior wall, septum and epicardium of the left ventricular endocardium in the RPC group at 10 min after LCX reperfusion (0.86 ± 0.27, 1.10 ± 0.34 and 1.2 0 ± 0.5 1ml · min-1 · g-1) was significantly higher than the control group (respectively 0.64 ± 0.28,0.69 ± 0.23 and 0.58 ± 0.226ml · min- 1 · g-1), P <0.05. RPC significantly reduced the incidence of ventricular fibrillation after reperfusion (8/9 in the control group, 2/10 in the RPC group, P <0.01). The mean aortic pressure of the control group was lower than that of the RPC group after coronary artery occlusion and reperfusion, but the difference was not significant (P> 0.05). Conclusions: RPC can significantly reduce the occurrence of ventricular fibrillation during myocardial ischemia and reperfusion, and its mechanism may be related to RPC significantly improving the endocardial blood supply.