急性心肌缺血激光心肌血管重建术与碱性成纤维生长因子联合应用对心脏功能及心肌存活性影响的实验研究(英文)

Effects of transmyocardial laser revascularization combined with basic fibroblast growth factor on myocardial viability and cardiac function in dog models with acute myocardial ischemia

目的 :评价急性心肌缺血激光心肌血管重建术 (TMLR)与碱性成纤维生长因子纤维蛋白胶 (bF GF FG)联合应用对缺血心肌存活性及心脏局部和整体功能的影响。方法 :18只健康杂种犬随机分为3组 ,即急性心肌缺血组 (AMI组 )、激光打孔组 (TM LR组 )和碱性成纤维生长因子组 (bFGF FG组 )。所在实验犬均结扎冠状动脉左前降支 ,建立急性心肌缺血模型。结扎后 30minTMLR组和bFGF FG组行激光心肌打孔 ,bFGF FG组于打孔后即刻将碱性成纤维生长因子纤维蛋白胶埋植入心肌激光隧道。 15只犬在冠脉结扎后 2mon进行了常规及脉冲组织多普勒多巴酚丁胺负荷超声心动图检查。另外 3只犬(每组 1只 )分别于术后 4 2、5 6和 60d死亡。结果 :左房室腔径 3组之间无明显差异 (P >0 .0 5 )。左室局部及整体功能参数TMLR组和bFGF FG组较AMI组改善 ,部分指标的组间差异有显著性 (P <0 .0 5或P <0 .0 1)。AMI组静脉输注小剂量多巴酚丁胺后 ,左室功能参数恶化 ,部分指标的变化有显著性意义(P <0 .0 5或P <0 .0 1)。TMLR组按 5 μg·kg-1·min-1静脉输注多巴酚丁胺后 ,左室功能参数改善 ,剂量增大到 10 μg·kg-1·min-1,上述功能参数呈现相反的变化趋势。bFGF FG组按 5 μg·kg-1·min-1静脉输注多巴酚丁胺后 ,左室功能参数改善 。

AIM: To assess the effects of transmyocardial laser revascularization (TMLR) combined with basic fibroblast growth factor fibrin glue (bFGF FG) on the myocardial viability and the cardiac regional and global function in dog models with acute myocardial ischemia (AMI). METHODS: Eighteen crossbred dogs were randomized to three groups. (AMI, TMLR and bFGF FG groups). The occlusion of the left anterior descending artery (LAD) of all animals was created in order to develop acute ischemic myocardium models. TMLR procedure was carried out 30 minutes after coronary ligation in both TMLR and bFGF FG groups, and afterward bFGF FG was planted in laser channels in bFGF FG group. 15 dogs underwent conventional and pulsed Doppler tissue imaging dobutamine stress echocardiography two months after LAD occlusion (other 3 dogs for each group died 42, 56 and 60 days after operation, respectively). RESULTS: There was no difference in the diameter of left atrium and ventricle among three groups (P> 0.05 ). The regional and globe function parameters of the left ventricle improved in the TMLR and bFGF FG groups gradually by turns, compared to the AMI group, of which there were significant differences in some variables among three groups (P< 0.05 or P< 0.01 ). In AMI group, the parameters above worsened during dobutamine infusion, of which some changed significantly (P< 0.05 or P< 0.01 ). In TMLR group, the parameters improved during dobutamine infusion in 5 μg·kg -1 ·min -1 , of which some changed significantly (P< 0.05 or P< 0.01 ), while they changed in reverse direction during dobutamine infusion in 10 μg·kg -1 ·min -1 . In bFGF FG group, the parameters improved during dobutamine infusion in 5 μg·kg -1 ·min -1 , of which some changed significantly (P< 0.05 or P< 0.01 ). There were no significant differences in all variables above during dobutamine infusion in 10 μg·kg -1 ·min -1 in comparison with in 5 μg·kg -1 ·min -1 (P> 0.05 ). CONCLUSION: TMLR can improve the perfusion of acute ischemic myocardium, and TMLR combined with bFGF FG can enhance improvement of myocardial perfusion to maintain the viability of ischemic myocardium and prevent the cardiac regional and global function from advancing impairment in acute myocardial ischemia.