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目的:探讨缺血后适应干预对兔急性心肌梗死(AMI)再灌注后心肌无复流的影响。方法:新西兰大白兔30只随机分为3组:对照组、手术组和缺血后适应组,每组各10只,制备AMI再灌注和缺血后适应的模型。结扎前、结扎1h末及再灌注2h末,于颈动脉采血,采用酶联免疫吸附法(ELISA)检测血清中超氧化物岐化酶(SOD)、高敏C反应蛋白(hs-CRP)的水平。采用心肌病理染色确定缺血区、无复流区及梗死区面积。结果:缺血后适应组的无复流范围及梗死范围明显大于手术组,差异有统计学意义(P<0.05)。各组结扎前血清SOD和hsCRP比较,差异无统计学意义(P>0.05);与对照组比较,手术组和缺血后适应组在结扎1h末及再灌注2h末血清SOD降低,hs-CRP增高,差异有统计学意义(P<0.05)。再灌注2h末,与手术组比较,缺血后适应组SOD增高,hs-CRP降低(P<0.05)。结论:缺血后适应可以减轻AMI再灌注后炎症反应,减少无复流的发生,缩小心肌梗死面积,改善患者的心功能。
Objective: To investigate the effect of post-ischemic postconditioning on myocardial no-reflow after acute myocardial infarction (AMI) reperfusion in rabbits. Methods: Thirty New Zealand white rabbits were randomly divided into three groups: control group, operation group and post-ischemic postconditioning group, with 10 rats in each group. Models of AMI reperfusion and post-ischemic adaptation were prepared. Serum levels of superoxide dismutase (SOD) and high-sensitivity C-reactive protein (hs-CRP) were measured by enzyme linked immunosorbent assay (ELISA) before ligation, at the end of ligation and at the end of 2h after reperfusion. Myocardial pathological staining to determine the ischemic area, no-reflow area and infarct area. Results: The extent of no-reflow and infarction in the post-ischemic group were significantly larger than those in the surgical group (P <0.05). The levels of serum SOD and hsCRP in each group before ligation were not significantly different (P> 0.05). Compared with the control group, the levels of serum SOD decreased and the levels of hs-CRP Increased, the difference was statistically significant (P <0.05). At the end of 2h after reperfusion, compared with the operation group, the SOD in the post-ischemic group increased and the hs-CRP decreased (P <0.05). Conclusion: Post-ischemic postconditioning can reduce the inflammatory response after AMI reperfusion, reduce the occurrence of no-reflow, reduce the infarct size and improve the cardiac function.