羊急性心肌梗死模型的麻醉方法及血心肌损伤标志物的变化

Anesthesia for Establishment of Animal Model of Acute Myocardial Infarction and Changes in Serum Markers of Myocardial Injury in Goat

目的探讨制作羊急性心肌梗死模型的麻醉方法；观察结扎左冠状动脉后心肌损伤标志物浓度的变化。方法选用成年羊共16只，经剑突下入路结扎左冠状动脉。麻醉采用气管插管、静脉内全麻及机械通气。术中连续监测ECG、MAP、CVP等。结扎前、结扎后1、3、6、12、24h分别抽取静脉血，以检测脂肪酸结合蛋白、CK-MB浓度。结果麻醉时间76—145（100．83±16．18）min。异丙酚用量9—23（16．79±3．16）mg，Kg，阿曲库铵用量0．8—1．4（1．07±0．39）mg／Kg。拔管时间为12—25（15．63±9．75）min。死亡4只，存活12只，存活率为75％。左冠状动脉结扎后心律失常以室性心律失常及心动过缓为主，常伴有MAP下降及CVP升高。术中需用利多卡因的为7例，需用阿托品的5例，需用升压药的6例，使用肾上腺素的5例，心内除颤的4例。存活动物模型中，LAD结扎后1、3、6、12h的血清脂肪酸结合蛋白（FABP）浓度均明显升高。结扎后3、6、12、24h的血清磷酸肌酸激酶同功酶（CK-MB）浓度均明显升高ECG复查结果显示所有存活模型均有心肌缺血及梗死的表现。心导管检查示结扎部位血流完全中断，梗死区心肌运动均明显异常（收缩与舒张运动减弱），3例模型中存在室壁瘤。组织病检示典型心肌坏死表现。结论气管插管及异丙酚，阿曲库铵静脉全麻用于羊急性心肌梗死模型的制备，简便、有效、安全。术中积极处理心律失常及血流动力学紊乱是提高存活率的关键。

Objective To explore method of anesthesia for estabfishing animal model of acute myocardial infarction induced by ligation of LAD and investigate changes in serum markers of myocardial injury in goat. Method Sixteen adult black goats were chosen in the model-preparation experiment. Intravenous anesthesia with Propefol/Atracurium and mechanical ventilation through intratracheal intubation was the main part of anesthesia. ECG, MAP and CVP were monitored continuously during anesthesia and procedure. Venous blood samples were obtained at different time points intra- and pest-operatively for measuring serum level of myocardial injury markers such as FABP and CK-MB. Results The duration of anesthesia and extubation time are 100.83 ± 16.18 min, 15.63 ± 9.75 min respectively. The dosages of Propefol and Atracurium were 16.79 ± 3.16 mg/Kg, 1.07 ± 0.39 mg/Kg respectively. Various arrhythmia and tremendous hemodynamic change often occurred during preconditioning and after ligation of LAD. Four animals died of VF after coronary ligation. The serum markers for myocardial injury such as FABP and CK-MB were increased markedly after LAD ligation. Lidocaine（7 cases）, atropine（5 cases）, Dopamine （5 cases）, Epinephrine（6 cases）, Adrenaline（5 cases） and intrathoracic defibrination（4 cases） were applied to correct Various arrhythmia and marked hemedynamic change. Conclusion The benefits of intravenous anesthesia with Propofol/Atracurium and mechanical ventilation through intratracheal intubation are simple, effective and safe. Active and efficient treatment of serious arrhythmia and marked hemedyuamic change is the key-point of management to ensure survival rate.