乳内动脉行选择性心中静脉动脉化模型的建立

Building a selective coronary vein bypass grafting animal model by using of internal mammary artery

目的:模拟右冠状动脉弥散性狭窄并使用右乳内动脉(RIMA),建立选择性心中静脉动脉化(CVBG)模型。方法:对14只小型猪应用高胆固醇饮食结合右冠状动脉多节段内膜剥脱术,诱发形成右冠状动脉重度弥散性狭窄。随机均分为对照组及实验组,在非体外循环下使用RIMA对实验组实施CVBG,对照组则进行单纯开胸术。术后6 h行冠状动脉造影、超声心动图、桥血管流量监测及非放射性彩色微球法检测心肌各层血流量等检查。结果:6只小型猪成功建立了CVBG模型。实验组缺血心肌经再灌注后平均血流量较对照组显著改善[(0.33±0.05)vs.(0.19±0.03)mL.g-1.min-1,P<0.05],实验组的心功能较对照组明显好转[(0.51±0.06)vs.(0.43±0.06),P<0.05]。结论:通过高胆固醇饮食结合右冠状动脉多节段内膜剥脱术,诱导右冠状动脉重度弥散性狭窄,使用RIMA与心中静脉吻合成功建立了CVBG模型,并初步证明CVBG可改善心肌缺血,具有进一步研究价值。

Objective：To build a selective coronary vein bypass grafting（CVBG）animal model by using of right internal mammary artery（RIMA） on basis of right severely diffuse coronary diseases.Methods：Severely diffuse diseases of right coronary artery were produced by breeding high-cholesterol food combined with right coronary endarterectomy in multi-positions in 14 swine.The swine with serious diffuse right coronary diseases were randomly divided into control and experiment groups.Off-pump CVBG were performed by anastomosing RIMA with middle cardiac vein in the experiment group.The control group received thoracotomy.Coronary angiography,graft flow,echocardiography and myocardial blood flow with non-radioactive colored microspheres were done or measured 6 hours after operations.Results：CVBG were successfully performed in six swine in the experiment group.There were significant improvements in myocardial flow[（0.33±0.05） vs.（0.19±0.03） mL·g-1·min-1,P0.05] and cardiac function [（0.51±0.06） vs.（0.43±0.06）,P0.05] in the experiment group compared with the control group.Conclusion：Severely diffuse right coronary diseases can be produced by breeding high-cholesterol food combined with right coronary endarterectomy in multi-positions.CVBG model can be established by anastomosing RIMA with middle cardiac vein.Ischemic conditions of myocardium can be relieved by CVBG which is worthy of further study.