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目的探讨在激光打孔的心肌孔道内埋植含有控制释放碱性成纤维细胞生长因子(bFGF)的纤维蛋白胶(FG)对急性心肌梗死(AMI)犬心脏形态和功能的影响。方法18只成年健康杂种犬于开胸后结扎左前降支(LAD),制作AMI模型。随机分为3组,每组6只。单纯心肌梗死(MI)组,直接关胸;激光心肌血运重建(TMR)组,于AMI30min后行透壁心肌打孔;bFGF组,则于AMI30min后行非透壁心肌打孔,并随即向孔道内注射含有bFGF的FG以封闭激光孔道。8周后行超声心动图和核素心肌显像,评价心脏形态和左心室收缩功能。结果MI组与TMR组于术后第22d和34d各有1只死亡,bFGF组无死亡。超声心动图检查,MI组和TMR组分别有2只和1只发生室壁瘤,bFGF组未见室壁瘤;与MI组和TMR组相比,bFGF组的左室前壁舒张期厚度(LVAW)更大;bFGF组和TMR组的射血分数(EF)均高于MI组;bFGF组每搏出量(SV)和心输出量(CO)均高于MI组和TMR组;3组之间室壁运动指数(WMI)差异均有显著意义。核素心肌显像心功能检测也显示,bFGF组的EF和SV均高于MI组与TMR组。结论在TMR孔道内使用FG控释bFGF安全可行,能减轻AMI后的心室重构,防止室壁瘤形成,改善左心室收缩功能,其疗效明显优于单纯TMR。
Objective To investigate the effects of fibrin glue (FG) containing controlled release of basic fibroblast growth factor (bFGF) on the morphology and function of heart in acute myocardial infarction (AMI) dogs in a laser-perforated cardiac tunnel. Methods Eighteen healthy adult dogs were anesthetized with left anterior descending artery (LAD) after thoracotomy. AMI models were made. Randomly divided into 3 groups, 6 in each group. In the myocardial infarction (MI) group, direct chest closure; laser myocardial revascularization (TMR) group, perforating transmyocardial myocardium 30 minutes after AMI; in bFGF group, nonpermeable myocardial perforating was performed 30 minutes after AMI, The intradermal injection of FG containing bFGF closes the laser tunnel. Echocardiography and radionuclide myocardial imaging were performed 8 weeks later to evaluate cardiac morphology and left ventricular systolic function. Results There was 1 death on the 22nd and 34th postoperative days respectively in MI group and TMR group, but no death in bFGF group. Echocardiography, MI group and TMR group were 2 and 1, respectively, aneurysm, bFGF group no aneurysm; compared with MI group and TMR group, bFGF group of left ventricular anterior wall diastolic thickness ( LVAW). The ejection fraction (EF) in bFGF group and TMR group were higher than that in MI group. The stroke volume (SV) and cardiac output (CO) in bFGF group were higher than those in MI group and TMR group. In group 3 Between the wall motion index (WMI) differences were significant. Cardiac imaging of radionuclide heart function tests also showed that, bFGF group EF and SV were higher than the MI group and the TMR group. Conclusion It is safe and feasible to use the FG controlled release of bFGF in the TMR channel, which can relieve the ventricular remodeling after AMI, prevent the formation of aneurysm and improve the left ventricular systolic function. The curative effect is better than that of simple TMR.