论文部分内容阅读
目的:动态评估远端缺血处理(RIC)对急性心肌梗死(AMI)后的左心室心肌灌注、心肌活性、心室重构、局部及整体心功能的保护作用。方法:取中华小型猪12头(雄性8头，雌性4头；6～8月龄)建立AMI模型，按随机数字表法分为RIC组和非RIC组，每组各6头。RIC组通过在后肢放置血压袖带充气诱导后肢缺血。所有小猪在术后第1天(1st，基线)、14天(14th，急性期)、28天(28th，亚急性期)和56天(56th，慢性期)行心肌灌注/代谢显像，获得心肌总灌注缺损程度(TPD)、存活心肌面积(HM)、梗死心肌面积(Scar)、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、室壁运动异常总分(SMS)和室壁增厚率异常总分(STS)及其与第1天相比的变化值。采用两独立样本n t检验和Mann-Whitney n U检验分析2组各指标及其变化值的差异。n 结果:共有9头模型猪存活并完成显像，其中RIC组5头，非RIC组4头。与非RIC组相比，RIC组28th的HM[(6.0±2.4)%与(17.0±4.6)%；n t＝-4.158]、TPDn 14th-1st[(-11.8±5.4)%与9.0%(4.5%，15.0%)；n z＝2.449]、TPDn 28th-1st[(-15.3±3.9)%与(12.0±3.0)%；n t＝-10.071]、TPDn 56th-1st[(-18.0±6.5)%与9.0%(4.5%，12.0%)；n z＝2.449]、HMn 28th-1st[(-10.5±6.9)%与(8.3±2.1)%；n t＝-4.507]、HMn 56th-1st[-15.0%(-17.5%，-8.5%)与2.0%(0%，7.0%)；n z＝2.449]、LVEDVn 14th-1st[-0.5(-2.5，0) ml与(13.0±4.4) ml；n z＝2.470]明显减小，差异均有统计学意义(均n P<0.05)。n 结论:RIC可以在AMI后改善心肌血流灌注，在急性期可以延缓心室重构的发生，在亚急性期及慢性期可以挽救存活心肌，从而保护心脏。“,”Objective:To evaluate the effect of remote ischemic conditioning (RIC) on left ventricular (LV) myocardial perfusion, myocardial viability, LV remodeling, regional and global LV function serially following acute myocardial infarction (AMI) in Chinese mini-pigs.Methods:AMI was established in 12 Chinese mini-pigs (8 males, 4 females; age: 6-8 months) and they were randomly divided into RIC group (n n=6) and non-RIC group (n n=6). RIC was performed in pigs by blood pressure inflation on the lower limbs for 5 min period and 4 cycles immediately after surgery. A series of myocardial perfusion imaging and gated n 18F-fluorodeoxyglucose (FDG) myocardial metabolism PET/CT imaging were performed longitudinally at the 1st, 14th, 28th and 56th days after AMI, and parameters including total perfusion defect (TPD), hibernating myocardium (HM), Scar, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), summed motion score (SMS), summed thickening score (STS) and changes of these parameters were obtained. Independent-samples n t test and Mann-Whitney n U test were used to analyze data.n Results:Nine Chinese mini-pigs survived after surgery and were performed imaging. Compared to non-RIC group (n n=4), HM at the 28th ((6.0±2.4)% n vs (17.0±4.6)%; n t=-4.158), TPDn 14th-1st ((-11.8±5.4)% n vs 9.0%(4.5%, 15.0%); n z=2.449), TPDn 28th-1st ((-15.3±3.9)% n vs (12.0±3.0)%; n t=-10.071), TPDn 56th-1st ((-18.0±6.5)% n vs 9.0%(4.5%, 12.0%); n z=2.449), HMn 28th-1st ((-10.5±6.9)% n vs (8.3±2.1)%; n t=-4.507), HMn 56th-1st (-15.0%(-17.5%, -8.5%) n vs 2.0%(0%, 7.0%); n z=2.449) and LVEDVn 14th-1st (-0.5(-2.5, 0) ml n vs (13.0±4.4) ml; n z=2.470) were reduced in RIC group (n n=5; all n P<0.05).n Conclusion:RIC can improve myocardial perfusion, delay LV remodeling in the acute stage and salvage hibernating myocardium in the subacute stage and chronic stage.