激光心肌血管重建术对犬缺血心肌血流量和氧代谢的影响

The Effect of TMLR on Myocardial Blood Flow and Myocardial Oxygen Metabolism in Ischemic Myocardium of Dogs

目的 探讨激光心肌血管重建术 (TMLR)对急性缺血心肌血流量和氧代谢的作用与机制。方法 18只犬随机等分为正常对照组、心肌缺血组、激光治疗组。采用连续型Nd∶YAG激光行TMLR。测左前降支冠状动脉(LAD)结扎前、结扎后 30min和 6 0min的心肌血流量 (MBF) ,动脉血氧含量 (Ca.O2 )和冠状窦血氧含量 (Ccs.O2 ) ,心肌氧耗量(MVO2 )和心肌氧利用率 (MEO2 )。结果 (1)缺血组和激光组LAD结扎后 30min ,MBF分别为 39 0 6ml± 5 33ml/ (10 0g心肌·min)和 5 1 35ml± 3 42ml/ (10 0g心肌·min) (P <0 0 5 ) ;结扎后 6 0min ,MBF分别为 35 77ml± 8 2 3ml/ (10 0g心肌·min)和 5 2 18ml± 4 82ml/ (10 0g心肌·min) (P<0 0 5 )。 (2 )缺血组和激光组LAD结扎后 6 0min ,Ccs.O2 分别为 7 35ml dl± 1 47ml dl和 5 82ml dl± 1 84ml dl(P <0 0 5 ) ;结扎后 30min ,MVO2 分别为 2 95ml± 1 35ml/ (10 0g心肌·min)和 4 42ml± 1 0 4ml/ (10 0g心肌·min) (P <0 0 5 ) ,结扎后 6 0min ,MVO2 分别为 2 35ml± 1 10ml/ (10 0g心肌·min)和 4 38ml± 0 93ml/ (10 0g心肌·min) (P <0 0 5 ) ;结扎后 6 0min ,MEO2 分别为(4 4 83± 9 83) %和 (5 9 33± 10 0 7) % (P <0 0 5 )。结论 TMLR可有效增加缺血?

Objective To investigate the effect and mechanism of transmyocardial laser revascularization (TMLR) on myocardial blood flow and myocardial oxygen metabolism in acute myocardial ischemia.Methods 18 adult dogs were randomly and evenly divided into the control, ischemic and TMLR groups. Continuous wave Nd∶YAG laser was used to TMLR. The parameters included myocardial blood flow (MBF), concentration of oxygen in the blood of artery and coronary sinus (C a.O 2 & C cs .O 2), myocardial oxygen uptake (MVO 2)and myocardial oxygen extraction(MEO 2)before and 30 min and 60 min after ligation of ligating the left anterior descending coronary artery (LAD). Results (1) In the ischemic and the TMLR groups, MBF 30 min after the LAD ligation were 39 06 ml±5 33 ml/(100 g myocardium·min) and 51 35 ml±3 42 ml/(100 g myocardium·min) (P<0 05), respectively, MBF 60 min after the LAD ligation were 35 77 ml±8 23 ml/(100 g myocardium· min) and 52 18 ml±4 82 ml/(100 g myocardium· min) (P<0 05), respectively. (2) In the ischemic and the TMLR groups, C cs .O 2 60 min after the LAD ligation were 7 35 ml/dl±1 47 ml/dl and 5 82 ml±1 84 ml /dl (P<0 05), MVO 2 30 min after the LAD ligation were 2 95 ml±1 35 ml/(100 g myocardium· min) and 4 42 ml±1 04 ml/(100 g myocardium· min) (P<0 05), respectively, MVO 2 60 min after the LAD ligation were 2 35 ml±1 10 ml/(100 g myocardium·min) and 4 38±0 93 ml/(100 g myocardium·min) (P<0 05), respectively, and MEO 2 60 min after the LAD ligation were (44 83±9 83)% and (59 33±10 07)% (P<0 05), respectively. Conclusions TMLR may effectively improve myocardial blood flow and myocardial oxygen metabolism in acute myocardial ischemia.