异丙酚或七氟烷复合瑞芬太尼对大鼠心肌缺血再灌注损伤的影响

Study on the Effects of Remifentanil Combined With Propofol or Sevoflurane for Myocardial Is-chemia-reperfusion in Rats

【目的】探讨异丙酚或七氟烷复合瑞芬太尼对大鼠心肌缺血再灌注损伤（IRI）的影响。【方法】选择60只清洁级大鼠，随机分为5组：缺血组、七氟烷组、异丙酚组、缺血再灌注组（I／R组）、假手术组（SO组），每组各12例。按照经典方法建立离体大鼠IRI，比较备组心肌梗死面积指数、凋亡指数、Toll样受体-2（TLR-2）、Toll样受体-4（TLR-4）、肿瘤坏死因子-α（TNF-α）、核转录因子-KB（NF-KB）、核糖体蛋白S6激酶（P-p70S6K）及心功能指标[左心室舒张末压（LVEDP）、左心室下降最大速率（-dp／dt）、左心室上升最大速率（＋dp／dt）、心率（HR）、左心室发展压（LVDP）]。【结果】异丙酚组、七氟烷组LVEDP、LVDP、HR与SO组比较差异无统计学意义（P〉0．05）；异丙酚组、七氟烷组＋dp／dt、-dp／dt、LVDP显著高于缺血组，低于I／R组，LVEDP显著低于缺血组和I／R组，HR显著高于缺血组和I／R组（P〈0．05），且异丙酚组和七氟烷组各项指标比较差异有统计学意义（P〈0．05）。异丙酚组、七氟烷组TLR-2、TLR-4、TNF-α、NF-KB蛋白、P-p70S6K蛋白表达量与S0组无显著差异（P均〉0．05）；异丙酚组、七氟烷组各项指标显著高于缺血组，低于I／R组（P〈0．05）；异丙酚组、七氟烷组两组间有显著差异（P〈0．05）。异丙酚组、七氟烷组心肌梗死面积指数与凋亡指数显著高于SO组，低于缺血组、I／R组，组间比较差异有统计学意义（P〈0．05）。【结论】对于心肌IRI大鼠，使用异丙酚复合瑞芬太尼麻醉，可保护大鼠心功能，降低心肌梗死面积指数，改善介质失调，促进p-p70S6K、NF_KB、TLR-2、TNF-α、TLR-4表达，降低大鼠心脏离体凋亡指数。

[Objective]To investigate the effects of propofol or sevoflurane combined with remifentanil on myocardial ischemia-reperfusion injury （IRI） in rats.[Methods] Sixty clean rats were randomly divided into 5 groups： ischemia grougroup, sevoflurane group, propofol group, ischemia reperfusion group （I/R group） and sham operation group （SO group） with 12 in each group. The IRI of rats in vitro was established according to the classical method. In each group, myocardial infarction area index, apoptosis index Toll-like receptor 2 （TLR-2） Toll-like receptor 4 （TLR-4）, tumor necrosis factor-α （TNF-α）, nuclear transcription factor- κB （NF-κB）, ribosomal protein s6 kinase （p-pTOS6K） and cardiac function indexes left ventricular end-diastolic pressure （LVEDP）, left ventricular maximum rate of decline （--dp/dt）, left ventricular maximum rate of rise] （＋dp/dt）, heart rate （HR）, left ventricular progressive pressure （LVDP） were compared.[Results] In the propofol group and the sevoflurane group, there was no significant difference in LVEDP, LVDP and HR compared with those in the SO group （ P〉0.05）, the ＋dp/dt, --dp/dt, LVDP in the propofol group and the sevoflurane group was significantly higher than those in the ischemic group, but lower than those of the I/ R group; LVEDP was significantly lower than that in the ischemia group and the I/R group （ P 〈0.05）, and the HR was significantly higher than that in the ischemia group and the I/R group （ P〈0.05） ,and there was significant difference between propofol group and sevoflurane group （P〈0.05）. There was no significant difference in the TLR-2, TLR-4, TNF-a, NF-κB protain, p-pTOS6K protein expression between the propofol groeup, the sevoflurane group and the SO group （mean P 〉0.05）. The indexes of the propofol group and the sevoflurane group were significantly higher than that of the ischemia group and lower than that of the I/R group （ P〈0.05）,there was significant difference between the propofol group and the sevoflurane group （ P〈0.05）. The myocardial infarction area index and apoptosis index in the propofol group and the sevoflurane group were significantly higher than those in the SO group and lower than that in the ischemia group and the I/ R group （P 〈0.05）.[Conclusion]For myocardial IRI rats, propofol combined with remifentanil anesthesia could protect cardiac function, decrease myocardial infarction area index, ameliorate the imbalance of media~ tors, promote the p-p70S6K,NF-κB, TLR-2, TNF-a, TLR-4 expression and decrease the apoptosis index of rat heart in vitro.