多普勒导丝评价缺血预处理保护冠状动脉微循环功能的实验研究

Protective effect of ischemic preconditioning on coronary microcirculation function by intracoronary Doppler guidewire assessment

目的 观察缺血预处理 (IPC)对短期冬眠心肌 (SHM )相关冠状动脉 (冠脉 )微循环功能的保护作用。方法 将建立SHM模型的 12只中国小型家猪随机分为 2组 :①对照组 (6只 ) ,只制备SHM模型 ;②缺血预处理组 (IPC组 ,6只 ) ,制备模型前给予缺血 5min、复灌 5min处理 ,重复 2次。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 )的变化情况。结果 两组模型制备后 10min时 ,APV、DSVR、CFR均较基础状态时明显下降 (P <0 .0 5或 P <0 .0 1) ,APV、DSVR在随后实验过程中无明显变化 ;3 0min时两组CFR均有进一步降低趋势 (P >0 .0 5 ) ,60min时对照组CFR较 3 0min时明显降低 (0 .96± 0 .2 7对 1.74± 0 .49,P <0 .0 5 ) ,而IPC组CFR与 3 0min时相比 ,差异无显著性意义 (1.77±0 .41对 1.83± 0 .3 9,P >0 .0 5 )。结论 SHM模型相关冠脉在急性重度狭窄 60min时发生微循环功能障碍 ,IPC对SHM相关冠脉微循环功能具有保护作用。

Objective To investigate the effect of ischemic preconditioning (IPC) on coronary microcirculation function in short-term hibernating myocardium(SHM) animal model.Methods Twelve little domestic Chinese pigs were established as the model of SHM by interventional method (closed-chest) and divided into 2 groups at random: the control group (CON group, n =6) and ischemic preconditioning group (IPC group, n =6).IPC was elicited by 2 cycle of 5 min of ischemia followed by 5 min of reperfusion 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 the establishment of model.Results APV,DSVR and CFR all decreased significantly in SHM model in both groups( P < 0.01 or P < 0.05 ),while APV,DSVR did not change obviously at the rest time. At 30 min after the establishment of model CFR tended to decrease( P > 0.05 ),at 60 min CFR of the CON group decreased significantly than before( 0.96 ± 0.27 vs 1.74 ± 0.49 , P < 0.05 ),while CFR of the IPC group did not change obviously( 1.77 ± 0.41 vs 1.83 ± 0.39 , P > 0.05 ).Conclusions The coronary microcirculation dysfunction happened at the time point of 60 min after coronary stenosis in SHM model,IPC can protect the coronary microcirculation function in SHM model.