等容血液稀释和维拉帕米对缺血再灌注心肌的保护

Protective efffcts of isovolumetric hemodilution and verapamil solution on ischemic reperfused myocardium

在犬的急性心肌缺血再灌注模型上，观察右旋糖酐４０等容血液稀释和维拉帕米注射液以及二者联合应用对心肌缺血再灌注损伤的防治作用。２４条犬随机分为４组：Ⅰ组（对照组，ｎ＝６）、Ⅱ组（稀释组，ｎ＝６）、Ⅲ组（维拉帕米组，ｎ＝６）、Ⅳ组（稀释加维拉帕米组，ｎ＝６）。结果：①血液流变学指标改变：Ⅱ、Ⅳ组在血液稀释或给予维拉帕米后，血液流变学指标和Ⅰ、Ⅲ组相比明显改善（Ｐ＜０．０５）；②心功能改变：再灌注后，Ⅰ组心功能指标明显恶化（Ｐ＜０．０５），Ⅱ组和Ⅲ组左室内收缩压力峰值（ｐＬＶＳ），左室内舒张末期压力（ｐＬＶＥＤ），左室内压力最大上升速率（＋ｄｐ／ｄｔ（ｍａｘ）），左室内压力最大下降速率（－ｄｐ／ｄｔ（ｍａｘ））与Ⅰ组相比明显改善（Ｐ＜０．０５）；Ⅳ组心功能指标则进一步好于Ⅱ、Ⅲ组（Ｐ＜０．０５）。提示：①右旋糖酐４０等容血液稀释能明显改善左心收缩和舒张功能，维拉帕米只能显著改善左室舒张功能；②二者合用能进一步改善左室收缩和舒张功能。

This paper reports the effects of isovolumetric hemodilution with dextran 40 and verapamil solution on reperfused acute ischemic myocardiaum.45 min coronary artery occlusion was followed by 300 min reperfusion in order to reproduce acute myocardial ischemia reperfusion models.Twenty four dogs were divided at random into four groups,six dogs for each group.Group Ⅰ:ischemic reperfusion group;GroupⅡ:hemodilution group;Group Ⅲ:verapamil group;Group Ⅳ:hemodilution+verapamil group.Results:①The changes of hemorheology:The hemorheologic conditions in Group Ⅰ and Ⅲ exacerbated further as compared with those in Group Ⅱ and Ⅳ,after the treatment had been given ( P <0.05).②The changes of cardiac function:After reperfusion all cardiac function parameters in Group I got worse and worse ( P <0.05); p LVSP p LVED ±d p /d t (max) in Group Ⅱ and p LVED in Group Ⅲ improved significantly as compared with those in Group Ⅰ.The parameters in Group Ⅳ were still better than those in Group Ⅱ,Ⅲ ( P < 0.05). The results suggested:①Isovolumic hemodieution with Dextion 40 could ameliorate the left ventricular systolic and diastolic function,while verapamail could only improve the left ventricular diastolic function.②The combination of the two therapies would further improve the left ventricular systolic and diastolic function significantly,reduce the infarct size,and show a better synergistic effect.