芬太尼后处理联合缺血后适应对兔心肌缺血再灌注损伤心肌坏死标志物的影响

Effect of fentanyl post-processing combined with ischemic postconditioning on markers of myocardial infarction in rabbits after myocardial ischemia and reperfusion injury

目的观察芬太尼后处理联合缺血后适应对兔心肌缺血再灌注损伤心肌坏死标志物及心肌梗死面积的变化,探讨其对心肌缺血再灌注损伤的保护作用。方法 32只日本大耳白兔,采用结扎左冠状动脉前降支30 min、复灌120 min建立心肌缺血再灌注损伤模型。按"随机数字表法"随机分为4组,每组8只:假手术组,动脉下仅穿线不结扎;缺血再灌注组,直接恢复再灌注;缺血后适应组,缺血后适应后恢复再灌注;芬太尼后处理+缺血后适应组,缺血28 min给予芬太尼5μg·kg-1后处理,30 min予以缺血后适应。测定各组心肌坏死标志物(心肌肌钙蛋白I浓度与肌酸激酶同工酶蛋白活力浓度)、计算心肌梗死面积及观察室性心律失常发生率。结果芬太尼后处理+缺血后适应组较缺血后适应组、缺血再灌注组外周血心肌肌钙蛋白I浓度、肌酸激酶同工酶酶蛋白活力浓度降低,心肌梗死面积减小,差异均有统计学意义(P<0.05)。缺血后适应组较缺血再灌注组外周血心肌肌钙蛋白I浓度、肌酸激酶同工酶酶蛋白活力浓度降低,心肌梗死面积减小,差异均有统计学意义(P<0.05)。芬太尼后处理+缺血后适应组、缺血后适应组较缺血再灌注组室性心律失常发生率降低[0 vs.50%(4/4),P<0.05;12.5%(1/7)vs.50%(4/4),P<0.05],差异均有统计学意义(P<0.05)。结论芬太尼后处理联合心肌缺血后适应显著降低兔心肌缺血再灌注心肌肌钙蛋白I浓度、肌酸激酶同工酶酶蛋白活力浓度,减少心肌梗死面积,降低室性心律失常发生率,可减轻心肌缺血再灌注损伤。

Objectives To explore the effect of fentanyl post-processing combined with ischemic postconditioning on markers of myocardial infarction and area of myocardium in rabbits after myocardial ischemia and reperfusion injury,and to assess its protective value.Methods After ligation of the left anterior descending （LAD） coronary artery for 30 minutes,a model of myocardial ischemia-reperfusion in 32 Japanese white rabbits was established by reperfusion for 120 minutes.The rabbits were randomly divided into four groups,8 in each group.Sham-operated group （S group）：to saperate origin of LAD without ligation;ischemia-reperfusion group （I/R group）：to restore reperfusion directly; ischemic postconditioning group （IPOC group）：to restore reperfusion after ischemic postconditioning; combination of fentanyl post-processing and ischemic postconditioning group （F＋IPOC group）：to give 5 μg· kg-1 fentanyl post-processing after ischemia for 28 minutes,ischemic postconditioning in 30 minutes.Differences in markers of myocardial necrosis [active concentration of creatine kinase-MB （CK-MB） and concentration of cardiac troponin-Ⅰ （c-TnI）],myocardial area and occurrence of arrhythmia were dectected.Results Concentration of c-TnI,active concentration of CK-MB and myocardial area in F＋IPOC group were significantly lower than those in IPOC and I/R groups （P〈0.05）.Concentration of c-TnI,active concentration of CK-MB and myocardial area in IPOC group were significantly lower than those in I/R group （P〈0.05）.Ventricular arrhythmia in F＋IPOC and IPOC groups were significantly lower than that in I/R group [0 vs.50% （4/4）,P〈0.05; 12.5% （1/7） vs.50% （4/4）,P〈0.05].Conclusions Fentanyl post-processing combined with ischemic postconditioning can significantly reduce concentration of c-TnI and active concentration of CK-MB,decrease myocardial area and occurrence of arrhythmia,and can lighten myocardial ischemia and reperfusion injury.