【摘要】 目的　检测急性心肌缺血犬模型行激光打孔心肌内埋植碱性成纤维生长因子缓释栓后缺血心肌的存活性 ,以评价该方法对缺血心肌灌注的影响。方法　 18条健康杂种犬随机分成 3组 ,即急性心肌缺血组(AMI组 )、激光打孔组 (TMLR组 )和激光打孔联合碱性成纤维生长因子缓释栓组 (bFGF FG组 )。所有实验犬均结扎左前降支中段造成急性心肌缺血模型 ,TMLR组和bFGF FG组在冠脉结扎后 3 0min于缺血区心肌用KTP激光打孔 ,bFGF FG组并于打孔的心肌隧道内埋植碱性成纤维生长因子缓释栓。术后 2个月用多普勒组织成像结合小剂量多巴酚丁胺负荷超声评价缺血心肌的存活性。结果　 3个实验组各有 1条犬死亡。静脉输注多巴酚丁胺后 ,AMI组左室前壁及前室间隔增厚率 (ΔT % )、左室前壁运动幅度 (MA)及舒缩速率参数收缩期峰值速率 (s)、舒张早期与晚期峰值速率比值 (e/a)以及二尖瓣瓣环运动速率参数e/a ,随着多巴酚丁胺剂量的增大逐渐降低 ,室壁运动记分指数 (WMSI)逐渐升高 (P <0 .0 5或P <0 .0 1) ;二尖瓣瓣环运动速度参数s无明显变化 (P >0 .0 5 )。TMLR组在静脉输注 5 μg·kg-1·min-1多巴酚丁胺后 ,ΔT %、MA、左室前壁及二尖瓣瓣环s和e/a升高 ,WMSI降低 (P <0 .0 5或P <0 .0 1) ;当多巴酚丁胺剂量增大到 10 μg·kg-1·m更多还原

【Abstract】 Objective To assess the effect of transmyocardial laser revascularization (TMLR) combined with basic fibroblast growth factor fibrin glue (bFGF FG) on the myocardial viability in acute myocardial ischemia (AMI).Methods Eighteen crossbred dogs were randomized into three groups,ie,acute myocardial infarct(AMI),TMLR and bFGF FG groups.The occlusion of the left anterior descending arteries (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.Fifteen dogs underwent Doppler tissue imaging dobutamine stress echocardiography two months after LAD occlusion (other 3 dogs for every group died 42,56 and 60 days after operation,respectively).Results In AMI group,thickening (ΔT%) of the anterior interventricular septum and left ventricular anterior wall,the motion amplitude (MA) of left ventricular anterior wall,the systolic peak velocity (s) and the early to late peak velocity ratio (e/a) of left ventricular anterior wall ,and e/a of mitral valve circle velocity decreased,wall movement score index (WMSI) increased gradually during dobutamine infusion(P< 0.05 or 0.01 ).In TMLR group,T%,MA,and s,e/a of both left ventricular anterior wall and mitral valve circle velocities increased,and WMSI decreased during dobutamine infusion in 5 μg·kg -1 ·min -1 (P< 0.05 or 0.01 ).All variables above changed in reverse direction during dobutamine infusion in 10 μg·kg -1 ·min -1 .In bFGF FG group,ΔT%,MA,and s of both left ventricular anterior wall and mitral valve circle velocities increased during dobutamine infusion in 5 μg·kg -1 ·min -1 (P< 0.05 or 0.01 ).The parameter WMSI inclined to decrease and e/a increase,but had no statistically significant change(P> 0.05 ).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 ).Conclusions TMLR could improve the perfusion of acute ischemic myocardium,when combined with bFGF FG, could enhance improvement of myocardial perfusion to maintain the viability of ischemic myocardium.更多还原