国际麻醉学与复苏杂志   2016, Issue (12): 0-0
    
肢体远隔缺血后处理联合吗啡后处理增强对心肌缺血/再灌注损伤的保护作用
王世玉, 崔昕龙, 薛富善, 刘和平, 李瑞萍, 刘高谱, 杨桂珍, 廖旭, 孙超1()
1.中国医学科学院整形外科医院
Combined morphine and limb remote ischemic postconditioning provides an enhanced protection against myocardial ischemia/reperfusion injury
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摘要:

目的 评估联合应用肢体远隔缺血后处理(remote ischemic postconditioning, RIP)和吗啡后处理能否获得增强的心肌保护作用。 方法 采用大鼠在体心肌缺血/再灌注损伤(ischemia/reperfusion injury, I/RI)模型,采用随机数字表法将60只大鼠分为6组(每组10只):空白对照组(Sham组)、缺血/再灌注(ischemia/reperfusion, I/R)组(I/R组)、缺血预处理(ischemic preconditioning, IPC)组(IPC组)、肢体RIP组(RIP组)、吗啡后处理组(M组)以及联合应用肢体RIP和吗啡后处理组(M+RIP组)。实验中连续监测心律失常情况,计算缺血期和再灌注早期的心律失常评分,检测血清肌酸激酶同工酶(creatine kinase MB, CK-MB)和心脏肌钙蛋白I(cardiac troponin I, cTnI)浓度,并采用伊文蓝和氯化三苯基四氮唑(triphenyltetrazolium chloride, TTC)双重染色法测定心肌梗死面积。 结果 I/R组、IPC组、RIP组、M组和M+RIP组的心肌梗死面积分别是(56.0±9.1)%、(23.9±5.5)%、(40.4±11.1)%、(47.7±9.3)%和(27.2±6.7)%。与I/R组比较,M+RIP组再灌注早期心律失常发生率和心律失常评分、血清CK?蛳MB和cTnI浓度以及心肌梗死面积均明显降低(P<0.05);这些参数在IPC组和M+RIP组之间差异无统计学意义(P>0.05)。 结论 在大鼠在体心肌I/RI模型,联合应用肢体RIP和吗啡后处理可获得增强的心肌保护作用,其心肌保护作用类似于IPC。

关键词: 缺血/再灌注损伤; 缺血后处理; 肢体远隔缺血; 吗啡; 心肌保护
Abstract:

Objective To determine whether combined morphine and limb remote ischemic postconditioning could provide an enhanced protection against myocardial ischemia/reperfusion injury. Methods Using rat in vivo myocardio ischemia/reperfusion injury(I/RI) model, sixty male SD rats were allocated into six groups(n=10) by random number method: control group (group sham), ischema/reperfusion(I/R) group(group I/R), ischemic preconditioning group(group IPC), remote ischemic postconditioning group(group RIP), morphine postconditioning group(group M), and combined morphine and remote ischemic postconditioning groups (group M+RIP). Arrhythmias were monitored continuously during the experiment and scored in early I/R period. Serum creatine kinase MB(CK-MB) and cardiac troponin I(cTnI) levels were assayed. The infarction area was determined by Evans blue and triphenyltetrazolium chloride(TTC) staining method. Results The infarction area was (56.0±9.1)%, (23.9±5.5)%, (40.4±11.1)%, (47.7±9.3)% and (27.2±6.7)% in the I/R, IPC, RIP, M and M+RIP groups, respectively. The infarction area, serum CK-MB, cTnI level, incidence and score of arrhythmias during early reperfusion period were significantly reduced in group M+RIP compared to group I/R(P<0.05), but showed no significant differences between IPC and M+RIP groups(P>0.05). Conclusions This experiment demonstrates that combined morphine and limb remote ischemic postconditioning provides an enhanced protection against myocardial I/RI which is comparable to ischemic preconditioning.

Key words: Ischemia/reperfusion injury; Ischemic postconditioning; Limb remote ischemic; Morphine; Myocardial protection