DADLE联合山莨菪碱对体外循环心肌保护作用的实验研究

An experimental study on the role of DADLE and Anisodine in cardioprotection during cardiopulmonary bypass

目的通过建立猪体外循环(cardiopulmonary bypass,CPB)心肌缺血再灌注(myocardial ischemia-reperfusion,MI/R)模型观察联合应用δ阿片受体激动剂DADLE和M受体拮抗剂山莨菪碱后的心肌保护作用,以期为临床心肌保护提供理论和实验依据。方法将16只成年家猪随机分为对照组、预处理两组(n=8),常规建立CPB模型,主动脉阻断同时灌注改良St.Thomas停搏液。每组于CPB前、主动脉开放时、CPB结束时、停机后1 h、停机后2 h检测冠状静脉窦血肌钙蛋白(cardiac troperin T,TnT)含量,相应时间点监测左室舒张末期压(LVEDP)和左室内压最大变化速率(±dp/±dtmax),分别于CPB前和停机后2 h取左心室心肌,以作心肌组织ATP含量的测定。并应用透射电镜观察心肌再灌注损伤超微结构的变化。结果和预处理组相比,对照组心功能指标明显下降。对照组的TnT较预处理组明显升高,相反,其ATP含量明显降低。透射电镜下预处理组的心肌超微结构损伤较对照组明显轻微。结论联合应用DADLE和山莨菪碱能产生较好的心肌保护作用。

Objective To study the combined effects of Muscarinic receptor antiagonist Anisodine and δ-opioid receptor agonist DADLE by establishing swine cardiopulmonary bypass（CPB） myocardial ischemia-reperfusion （MI/R） modd, and to provide academic and experimental evidences for clinical cardioprotection. Methods Sixteen adult swine were randomly divided into 2 groups： control group and preconditioninggroup （n = 8）. CPB was instituted routinely and the improved St. Thomas cold cardioplegic solution was administered into the root of aorta. Blood samples were taken from coronary sinus before CPB and TnT were measured at the begin- ning of reperfusion, the end of CPB, one hour after CPB and two hours after CPB. LVEDP and ± dp/± dtmax were measured at the same time points. Left ventricular myocardium of specimens were taken before CPB and two hours after CPB to mesure the contents of ATP. And the myocardium ultrastructures were observed by transmission electron microscope. Results Parameters of cardiac function in control group decreased significantly than those in pretreatment group. Conclusion of TnT increased significantly in control group as compared with that in pretreatment group while the values of ATP decreased significantly in control group. Pretreatment group showed slightes injuries in myocardium under transmission electron microscopy than those in control group. Conclusion Combined Anisodine and DADLE shows significant effects on cardioprotection in swine experimental study.