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目的:探讨不同时间开始给予极化液(葡萄糖-胰岛素-钾液,G IK)对犬心肌缺血/再灌注(M I/R)后心脏功能及心肌细胞损伤的影响。方法:制备犬M I/R模型,心肌定量缺血(左前降支血流量降低80%)50 m in,再灌注4 h。分别于:①再灌注前30 m in(再灌注前)、②再灌注即刻(再灌注时)、③再灌注后1 h(再灌注后)给予G IK。观察对动脉血压、心率、左室压的影响及测定心大静脉血清乳酸脱氢酶(LDH)、肌酸激酶(CK)活性,再灌注结束后检测心肌梗死率或细胞凋亡指数。结果:与再灌注后组相比,再灌注前组和再灌注时组可明显改善再灌注后左室收缩及舒张功能,降低血清CK、LDH活性,减少心肌梗死范围[分别为(5.9±1.1)%和(5.2±0.8)%vs(9.1±1.2)%,均P<0.01]、抑制心肌细胞凋亡的发生[(4.6±0.9)%和(3.7±1.1)%vs(8.9±2.3)%,均P<0.05]。结论:再灌注早期给予G IK可降低M I/R引起的心肌细胞损伤,促进再灌注后心脏功能的恢复,在再灌注后1 h给予G IK对心脏的上述保护作用则明显减弱。
OBJECTIVE: To investigate the effects of different doses of pooled liquid (glucose-insulin-potassium solution, G IK) on cardiac function and cardiomyocyte injury after myocardial ischemia / reperfusion (M I / R) in dogs. Methods: The canine M I / R model was established. Myocardial ischemia (left anterior descending branch blood flow reduced by 80%) for 50 min and reperfusion for 4 h. Respectively: ① 30 min before reperfusion (before reperfusion) ② immediately after reperfusion (reperfusion) ③ 1 h after reperfusion (after reperfusion) G IK. The effects on arterial blood pressure, heart rate and left ventricular pressure were observed. Serum lactate dehydrogenase (LDH) and creatine kinase (CK) activity were measured. The myocardial infarction rate and apoptosis index were measured after reperfusion. Results: Compared with the post-reperfusion group, the pre-reperfusion group and the reperfusion group significantly improved left ventricular systolic and diastolic function, decreased serum CK and LDH activities and decreased the infarct size [5.9 ± 1.1 (4.6 ± 0.9)% and (3.7 ± 1.1)% vs (8.9 ± 2.3)%, respectively, and (5.2 ± 0.8)% vs %, All P <0.05]. CONCLUSION: G IK in early reperfusion can reduce myocardial injury caused by M I / R and promote the recovery of cardiac function after reperfusion. The protective effect of G IK administered 1 h after reperfusion on heart is obviously weakened.