冠状动脉堵闭法与栓塞法制备小型猪心肌梗死模型的对比

Model establishment of acute myocardium infarction induced by coronary occlusion versus balloon occlusion in miniature pigs

背景:冠状动脉栓塞法和球囊堵闭法为制备小型猪急性心肌梗死模型最常用的两种方法,但由于猪价格昂贵,制作心肌梗死模型后还要进行多种实验研究,故选择耗时短、损伤小、术后存活率高的手术方法非常必要。目的:对比运用冠状动脉栓塞法与经皮腔内冠状动脉成形术球囊堵闭法制备猪急性心肌梗死动物模型的差异。设计、时间及地点:随机分组,对比观察动物实验,于2009-05-08/08-03在昆明医学院第一附属医院心脏介入室完成。材料:西双版纳小耳猪20只,体质量20～30kg,雌雄不限,购自昆明医学院动物科,随机抽签法分成栓塞组(n=10)和堵闭组(n=10)。方法:栓塞组麻醉后经股动脉置入球囊至冠状动脉前降支远端,给予球囊扩张压力202.65kPa阻断前向血流1,2,5min,每次间隔60s,建立猪急性心肌梗死动物模型。堵闭组麻醉后经股动脉置入球囊到达冠状动脉前降支远端后,同样给予球囊扩张压力202.65kPa阻断前向血流1,2,5min,每次间隔60s,然后持续阻断前向血流60min,建立猪急性心肌梗死动物模型。主要观察指标:通过冠脉造影、心电图、心肌酶谱、心脏彩超及病理学检测比较两种方法建立心肌梗死模型的异同。结果:栓塞组有9只猪完成模型制备,1只因冠状动脉破裂死亡。术毕即见相关导联T波深倒,未见明显ST段抬高,术后1d相关导联ST段抬高0.1～0.2mV;手术共耗时11h。堵闭组猪存活5只,4只因室颤死亡,1只不明原因死亡。术毕即见相关导联ST段明显抬高0.2～0.3mV;手术共耗时24h。两组实验动物心脏彩超均在梗死部见局部运动异常,术后4周栓塞组有3只,堵闭组1只左室室壁瘤形成。肌酸激酶同功酶及血浆肌钙蛋白均明显升高并呈动态演变,梗死区心肌坏死明显,细胞内结构溶解消失,两组比较无明显差异。结论:运用栓塞法和堵闭法均能成功建立小型猪急性心梗动物模型。栓塞法较堵闭法更简易,造成的损伤较小,术后恢复较快,死亡率小。

BACKGROUND： Coronary occlusion and balloon occlusion are two major methods in prepar/ng acute myocardium infarction models. The pigs were expensive and the models will perform further study, therefore, it is necessary to prepare a model with advantage of short time consuming, few trauma, and high survival rate. OBJECTIVE： To establish acute myocardium infarction in miniature pigs induced by coronary occlusion and balloon occlusion, and to compare the differences. DESIGN, TIME AND SETTING： The randomized grouping, contrast observation animal experiment was performed at the heart intervention room of The First Affiliated Hospital of Kun Ming Medical College between May 6th and August 3rd, 2009. MATERIALS： A total of 20 Banna miniature pigs, weighing 20-30 kg, irrespective of genders, were purchased from animal department of Kunming Medical College. The animals were equally divided into embolism and occlusion groups. METHODS： In the embolism group, the balloon was implanted into distal end of anterior descending coronary via femoral artery, blocked the forward flow with 202.65 kPa pressure for I, 2, and 5 minutes, with 60 seconds interval. The same operation was performed in the occlusion group, followed by blocked the forward flow for successive 60 minutes. MAIN OUTCOME MEASURES： Differences of modes established by 2 methods were compared by coronary opacification, ECG, myocardium zymogram, ultrasonic cardiogram and pathology detection. RESULTS： Nine pigs were survived in the embolism group, and the remained I pig died of coronary artery rupture. After operation, T wave inversion could be found, without ST stage raise. At day I after operation, correlated lead ST stage was raised 0.1-0.2 inV. The operation duration was 11 hours. In the occlusion group, 5 pigs survived, 4 pigs died of ventricuiar fibrillation, and I died without definite cause. The operation cost 24 hours, and the correlated lead ST stage was increased 0.2-0.3 mV postoperatively. Motion abnormality in infarction place was exhibited in both groups; ventricular aneurysm was formed in 3 pigs in the embolism group, and I in the occlusion group. Levels of creatine kinase isoenzymes serum troponin T were obviously stepped up and presented dynamic changes. The myocardiolysis was obviously showed in the infarcted areas, but the differences were no obviously in 2 groups. CONCLUSION： Both coronary occlusion and balloon occlusion can induce models of acute myocardium infarction. The coronary occlusion method is superior to balloon occlusion with few trauma, faster postoperative recover and low mortality rates.