激光打孔术后新生微血管和心肌细胞状态的观察

Observation of neonatal microvessels and status of myocardial cells after transmycardial laser revascularization

目的 :本实验主要观察激光心肌血管成行术后 ,激光孔道周围微血管的变化及缺血区心肌细胞的状态。方法 :选用 18只健康杂种犬 ,随机分为三组 ,采用结扎方法造成左室前侧壁心肌缺血和梗塞 ,使用KDML 2型钕激光 ,功率 2 5W ,波长 1 0 0 μm ,在犬缺血区经心外膜造成一系列透壁及非透壁的激光孔道。透壁组 (TG)采用激光在心室缺血区造成 10～ 15个贯穿左室壁的激光孔道 ;非透壁组 (NTG)在缺血区用激光产生 10～ 15个非透壁的激光孔道 ;对照组 (CG)不做任何处理。结果 :2月后①TG和NTG激光孔道周围的微血管数量明显多于CG ;TG和NTG微血管数量统计学处理无显著差异 ;但TG微血管面积大于NTG。②CG心肌胶原含量最高 (19 4 3±2 6 5 ) % ;NTG次之 (9 31± 1 0 2 ) % ;TG最低 (5 19± 0 5 4 ) %。③TG心肌细胞内线粒体损伤最轻 (Flameng 0～ 1级 ) ,CG多为不可逆性损伤 (Flameng 3～ 4级 )。 结论 :激光心肌血管重建术有助于缺血心肌的灌注改善 ,促进了激光孔道周围微血管的增生。

Objective:To observe angiogenesis surrounding laser channel and status of myocardial cells in ischemia area after transmycardial laser revascularization Methods: the 18 dogs were randomly divided into 3 group ,six served as non transmural group(NTG), six as transmural group(TG), six as control group(CG) Left anterial decend artery(LAD) was ligated at about the junction of its proximal and medial thirds to induce myocardial ischemia The 10～15 channels were created with the neodymium laser in ischemic area two months later, the dogs were sacrificed Image analysis system was engaged to evaluate the content of interstitial collagen, density of microvessels and areameter of microvessels Electronic microscope was used to observe the changes of mitochondria Results: at two months ①the density of microvessels around the channels both in TG and NTG was higher( P <0 05) than that of the control group, the areameter of TG was greater than that of NTG ②amount of collagen in CG was 19 43±2 65% versus in NTG 9 31±1 02% ( P <0 05) and versus in TG 5 19±0 54%( P <0 05) ③Degree of mitochondrial injury was normal or slightly damaged in TG, but were irreversible damaged in CG Conclusion: Transmycardial laser revascularization results in significant improvement in myocardial perfusion and induces angiogenesis in ischemic myocardium