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目的探索结扎小型猪冠状动脉左前降支(LAD)建立急性心肌梗死(MI)模型及进行血流评价的方法。方法小型猪20头,全麻下开胸暴露心脏,预阻断冠状动脉左前降支(第2对角支)15 min后予以结扎。术中进行心电图动态监测,术后进行冠状动脉造影及检测血清心肌酶谱以确定模型建立的情况。以冠状动脉造影评价MI溶栓治疗的血流分级(TIMI-FG);13氮-氨正电子发射断层显像(13N-NH3PET)测定心肌血流评价手术后血流的改变。结果在小型猪20头中有16头存活4周,成活率80%。开胸手术中1头因麻醉意外死亡,3头死于术后呼吸不畅。结扎后,心电图呈动态变化,24 h后血清心肌酶谱(肌酸激酶、肌酸激酶同工酶、肌钙蛋白I)的水平较术前明显增高(P<0.01)。冠状动脉造影显示,LAD血流中断证实MI模型建立成功。术后3 d,冠脉造影血流TIMI分级及13N-NH3PET测定心肌血流量较术前有明显变化。结论开胸手术成功率高,术后血流评价方法可用于手术前后冠脉血流和心肌血流的比较,以及对MI后治疗的效果进行评价。
Objective To explore the method of establishing acute myocardial infarction (MI) model and assessing blood flow by ligating left anterior descending coronary artery (LAD) of miniature pigs. Methods Twenty minigt pigs were exposed to the thoracotomy under general anesthesia, and the left anterior descending coronary artery (the second diagonal branch) was occluded for 15 minutes before being ligated. Intraoperative ECG monitoring, postoperative coronary angiography and detection of serum myocardial enzymes to determine the establishment of the model. The blood flow grade (TIMI-FG) was evaluated by coronary angiography in thrombolytic therapy of MI. 13N-NH3PET was used to evaluate the changes of blood flow after myocardial flow evaluation. As a result, 16 of the 20 miniature pigs survived for 4 weeks with a survival rate of 80%. Thoracotomy in an accident died of anesthesia, 3 died of postoperative respiratory failure. After ligation, the electrocardiogram showed a dynamic change. After 24 hours, serum myocardial enzymes (creatine kinase, creatine kinase, and troponin I) were significantly increased (P <0.01). Coronary angiography showed that interruption of LAD blood flow confirmed the successful establishment of the MI model. At 3 days after operation, TIMI grading of coronary angiography and 13N-NH3PET showed significant changes in myocardial blood flow compared with those before operation. Conclusion The success rate of thoracotomy is high. The postoperative blood flow evaluation method can be used to compare the coronary blood flow and myocardial blood flow before and after operation, and the effect of post-MI treatment is evaluated.