多普勒导丝对腺苷预处理保护冠状动脉微循环功能的评价

Assessing the protective effect of adenosine preconditioning on coronary microcirculation function by intracoronary Doppler guidewire

目的 :观察腺苷预处理 (APC)对缺血心肌相关冠状动脉 (冠脉 )微循环功能的保护作用。方法 :将建立心肌缺血模型的 12只中国小型家猪随机分为两组 :对照组 6只 ,仅制备心肌缺血模型 ;APC组 6只 ,制备模型前经冠脉注入腺苷 6mg。应用冠脉内多普勒导丝观察模型相关冠脉平均峰值流速 (APV)、舒张收缩流速比值(DSVR)、冠脉血流储备 (CFR)的变化。结果 :两组模型冠脉狭窄后 10min时APV、DSVR、CFR均较基础状态时明显下降 (P <0 .0 5或 <0 .0 1) ,APV、DSVR在随后实验过程中无明显变化 ;30min时两组CFR均有进一步降低趋势 (P >0 .0 5 ) ;6 0min时对照组CFR较 30min时明显降低〔(0 .96± 0 .2 7)∶(1.74± 0 .4 9) ,P <0 .0 5〕 ,而APC组CFR与 30min时相比差异无统计学意义〔(1.6 4± 0 .30 )∶(1.79± 0 .38) ,P >0 .0 5〕 ;但 12 0min时APC组CFR较前明显下降〔(0 .94± 0 .31)∶(1.6 4± 0 .30 ) ,P <0 .0 1〕 ,与同时间点对照组相比差异无统计学意义。结论 :心肌缺血模型相关冠脉在急性重度狭窄 6 0min时发生微循环功能障碍 ,APC对冠脉微循环功能具有保护作用 ,但持续时间较短。

Objective:To investigate the protective effect of adenosine preconditioning (APC) on coronary microcirculation function after myocardial ischemia.Method:Twelve little domestic Chinese pigs were established to the model of myocardial ischemia by interventional method (closed-chest) and divided into 2 groups at random: thecontrol group (CON group, n=6) and adenosine preconditioning group (APC group, n=6). APC was elicited by intracoronary infusion of adenosine before the establishment of model. Intracoronary Doppler guidewire was used to measure average peak velocity (APV) , diastolic systolic velocity ratio (DSVR) and coronary flow reserve (CFR) of the distal to the stenosis at the baseline and 10 min, 30 min, 60 min, 120 min after coronary stenosis.Result:APV, DSVR and CFR all decreased significantly in both groups (P< 0.01 or P< 0.05) after coronary stenosis, while APV, DSVR did not change obviously at the rest time. At 30 min after coronary stenosis CFR of the two groups tended to decrease (P> 0.05). At 60 min CFR of the CON group decreased significantly than that before 〔( 0.96± 0.27) vs ( 1.74± 0.49),P< 0.05〕, while CFR of the APC group didn't change obviously 〔( 1.64± 0.30) vs ( 1.79± 0.38), P> 0.05〕. At 120 min CFR of APC group decreased significantly than that before 〔( 0.94± 0.31) vs ( 1.64± 0.30),P< 0.01〕, there was no significant difference between two groups.Conclusion:The coronary microcirculation dysfunction was happened at the time point of 60 min after severe coronary stenosis, APC can protect the coronary microcirculation function, but the lasting time was short.