异丙酚、芬太尼对离体心肌缺血再灌注损伤的影响

Effects of propofol and fentanyl on myocardial ischemia-reperfusion injury in isolated rat heart

目的 评价异丙酚、芬太尼对离体心肌缺血再灌注损伤的作用。方法 采用离体鼠Langendroff脏模型,SD大鼠 32只,取心脏用 K-H液恒温恒压主动脉逆灌、平衡 15min,随机分为 4组:（A）脂肪乳剂对照组;（B）5μg·ml-1异丙酚组;（C）10ng·ml-1芬太尼组;（D）5μg·ml-1异丙酚加10ng·ml-1芬太尼组。用含相应药液的 K-H液灌注 10min,常温全心停灌30min,然后用含相应药液的K-H液恢复灌注30min,记录各组用药前、停灌前1min、再灌30min时心脏机械功能变化、冠脉流量以及测定再灌注30min冠脉流出液里乳酸脱氢酶（LDH）活性。结果 再灌30min时B、C、D组心功能的恢复明显好于A组,D组明显好于B、C组。LDH活性B、C、D组明显低于A组,D组明显低于B、C组。结论5μg·ml-1异丙酚、10ng·ml-1芬太尼能抑制离体心肌缺血再灌注损伤,两者复合应用其作用更强。

Objective To investigate the protective effect of propofol and/or fentanyl in myocardial ischemia-reperfusion injury. Methods Thirty-two SD rats weighing 250-300g were anesthetized with intraperitoneal ketamine 80 mg. Their hearts were excised and perfused with oxygenated (95%O2 and 5% CO2) K-H solution in a Langendorff apparatus at a perfusion pressure of 7.8 kPa. The temperature of perfusate and heart were kept at 37 ℃ . The experiment was divided randomly into four groups: A control group was perfused with K-H solution containing intralipid 90 μg·kg-1 ( n = 8); B propofol group was perfused with K-H solution containing propofol 5μg·kg-1 ; C fentanyl group was perfused with K-H solution containing fentanyl 10 ng·kg-1; D propofol-fentanyl group was perfused with K-H solution containing propofol 5μg ·kg-1 and fentanyl 10 ng·kg-1. The isolated heart was perfused with above mentioned perfusate for 10 min followed by 50 min global normothermic (37℃) ischemia and 30 min reperfusion. The left ventricular developed pressure (LVDP) and ±dp/dtmax and coronary flow were measured 1 min before propofol and/or fentanyl perfusion, 1 min before global ischemia and at the end of 30 min reperfusion. The lactate dehydrogenase(LDH) activity in the total coronary effluent collected during the 30 min reperfusion was measured. Results The recovery of LVDP and ± dp/dtmax and coronary flow at the end of 30 min reperfusion were significantly better in group B, C and D than those in control group and the recovery was best in group D. The release of LDH in coronary effluent decreased significantly at the end of 30 min reperfusion in group B, C and D as compared with that in control group. LDH release was least in group D. Conclusions Both propofol and fentanyl can protect myocardium against ischemia- reperfusion injury in isolated rat hearts. The protective effect of propofol and fentanyl can be added and better protection can be provided.