国际麻醉学与复苏杂志   2016, Issue (11): 0-0
    
心肌缺血再灌注后多巴酚丁胺最佳应用时间的探讨
王慧, 刘金东1()
1.徐州医学院
Discussion of the best time to use Dobutamine after myocardium ischemia-reperfusion.
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摘要:

【摘 要】 目的 制作大鼠离体心脏缺血-再灌注损伤模型,比较再灌注后不同时间点给予多巴酚丁胺对心功能和心肌损伤的影响,以探索心肌缺血再灌注后给予多巴酚丁胺的最佳时间。 方法 雄性SD大鼠36只,按照完全随机设计的方法分为4组(n=9),在Langendorff灌注装置上建立离体心脏缺血-再灌注损伤模型。平衡灌注15min,缺血30min,再灌60min,于再灌注期采取不同处理措施。单纯缺血再灌注组(I/R组):再灌注期全程以K-H液灌注;多巴酚丁胺一组(D1组):再灌注5min时给予多巴酚丁胺灌注30min,其余时间以K-H液灌注;多巴酚丁胺二组(D2组):再灌注15min时给予多巴酚丁胺灌注30min,其余时间以K-H液灌注;多巴酚丁胺三组(D3组):再灌注25min时给予多巴酚丁胺灌注30min,其余时间以K-H液灌注。其中,多巴酚丁胺输注剂量均为10ug/kg/min。记录各组平衡灌注末(T0),再灌注10min(T1)、20min(T2)、30min(T3)、60min(T4)时的血流动力学指标:心率(HR)、左室舒张末压(LVEDP)、左室发展压(LVDP)、左室内压上升/下降最大速率(±dp/dtmax)及冠脉流量(CF)。留取T0-T4各时间点冠脉流出液,按照乳酸脱氢酶(LDH)和肌酸磷酸激酶(CK)试剂盒测定冠脉流出液中LDH和CK的活性。TTC染色法测定心肌梗死面积(MIS)。Western blot法检测SERCA2a和RyR2蛋白表达量。 结果 D1组在给予多巴酚丁胺后,HR、LVEDP、LDH、CK、MIS均比I/R组高,差异有统计学意义(P<0.05);D2,D3组在给予多巴酚丁胺后HR、CF、LVDP、±dp/dtmax 高于I/R组(P<0.05),而LVEDP 、LDH、CK、MIS和I/R组相比差异无统计学意义(P>0.05)。多巴酚丁胺各组SERCA2a蛋白表达量和I/R组相比差异无统计学意义(P>0.05),而RyR2蛋白表达量则高于I/R组(P<0.05)。D2组与D3组相比在给与多巴酚丁胺后上述指标均无统计学差异(P>0.05)。 结论 大鼠心肌缺血后再灌注15min时应用多巴酚丁胺要优于其它时间点。在这一时间点用药可以及时而有效的提高大鼠心率,增加冠脉流量,改善心肌收缩功能,且不会加重心肌损伤。

关键词: 心肌缺血再灌注损伤 多巴酚丁胺 钙超载
Abstract:

【Abstract】 Objective Using isolated rat heart ischemia reperfusion model to compare the effects on cardiac function and myocardial injury of giving Dobutamine at different time points after reperfusion and to explore the best time to use Dobutamine after myocardium ischemia reperfusion. Methods 36 male SD rats, establishing isolated heart ischemia reperfusion injury model in Langendorff perfusion apparatus with 15min equilibrium, 30min global ischemia and followed by 60min reperfusion., were divided into four groups (n=9) according to the method of completely random design. Different treatment was taken in reperfusion period. Ischemia reperfusion group (I/R group): reperfused with K-H solution; Dobutamine group one (Group D1): giving dobutamine infusion for 30min after 5min of reperfusion,other time perfused with K-H solution. Dobutamine group two (Group D2): giving dobutamine infusion for 30min after 15min of reperfusion,other time perfused with K-H solution. Dobutamine group three (Group D3): giving dobutamine infusion for 30min after 25min of reperfusion,other time perfused with K-H solution. Dobutamine infusion dose was 10ug/kg/min. Record heart function indexes of each group at the end of balance reperfusion (T0) and 10min (T1), 20min (T2), 30min (T3), 60min (T4) of reperfusion: heart rate (HR), left ventricular end diastolic pressure (LVEDP), left ventricular developed pressure (LVDP), the maximum rate of left ventricular pressure change (±dp/dtmax) and coronary flow (CF). Take the coronary flow at T0-T4 time points to measure the activity of LDH and CK according to the test methods attached to lactate dehydrogenase (LDH) and creatine kinase (CK) test kit. Myocardial infarct size (MIS) were measured with TTC staining method. SERCA2a and RyR2 expression was determined by Western bloting. Results After given dobutamine, HR, LVEDP, LDH and CK activity and MIS of Group D1 were higher compared with Group IR(P<0.05). Meanwhile after given dobutamin, HR , CF, LVDP, ±dp/dtmax of Group D2 and D3 were higher than that of Group IR, but there was no significant difference in LVEDP, LDH and CK activity and MIS compared with Group IR (P > 0.05). SERCA2a expression between groups was no significant difference. While RyR2 expression were higher of groups with dobutamin compared with Group IR. There was no significant difference in data above between Group D2 and D3 after given dobutamine. Conclusion Giving Dobutamine after 15min of myocardial ischemia reperfusion in rats is superior to the other time points. Giving Dobutamine at this time point can timely and effectively improve the heart rate, increase the coronary flow, improve the myocardial contractile function, and does not aggravate the myocardial injury.

Key words: myocardial ischemia reperfusion injury; Dobutamine;Calcium overload