【作者】 胡强；

【导师】 龙村； 黑飞龙； 刘晋萍； 于坤；

【作者基本信息】 中国协和医科大学 ， 麻醉学， 2010， 博士

【摘要】 研究目的探讨乳化异氟醚对成年大鼠离体心脏心肌缺血-再灌注(I／R)损伤的影响。研究方法32只成年SD大鼠随机分成4组(每组n=8)即：STH液组,脂肪乳组,乳化异氟醚H组(5mmol／1),乳化异氟醚L组(1mmol／1)。每组均接受4℃停跳后,在30℃下接受60min停灌,37℃复灌60min。测定各组心脏机械功能,冠脉流出液中心肌肌钙蛋白I(cTnI)的含量,取左室心肌测定丙二醛(MDA)含量及电镜检查。研究结果乳化异氟醚L组和脂肪乳组可显著增强左室发展压,减少冠脉流出液中cTnI的含量(P<0.01),减少心肌丙二醛(MDA)含量；心肌细胞电镜观察显示两组心肌细胞损伤轻于STH液组。H组乳化异氟醚显著减低左室发展压,增加冠脉流出液中中cTnI的含量(P<0.01),增加心肌丙二醛(MDA)含量；心肌细胞电镜观察显示心肌细胞损伤明显高于其余各组。结论低浓度乳化异氟醚强化停跳液可改善心脏机械功能,促进离体成年大鼠心脏心肌缺血-再灌注(I／R)后血流动力学恢复,可减轻成年大鼠心肌缺血-再灌注损伤。研究目的探讨乳化异氟醚对离体大隐静脉舒张功能影响。研究方法取材于临床冠状动脉旁路移植术剩余的成人新鲜大隐静脉。采用器官槽法,分别检测用重碳酸盐缓冲液(KH液)、1mmol／l乳化异氟醚、含30%脂肪乳的重碳酸盐缓冲液和HTK液浸泡血管环1h后,再用7μmol／L indomethacin和300nmol／L LNNA作用后,检测30 nmol／L U46619及不同浓度A23187引发的血管收缩舒张反应。研究结果U46619引发的血管环预收缩强度,各组间差别无显著性差异(P>0.05)；A23187引起的内皮源性舒张,重碳酸盐缓冲液(KH液)及含1mmol／1乳化异氟醚,脂肪乳三组间无显著性差异(P>0.05),HTK液组与其余三组间有显著性差异(P<0.01)；电镜下,HTK液组对内皮损伤最轻,其余三组损伤基本一致。结论1mmol／1乳化异氟醚对血管内皮无明显损伤作用,不影响大隐静脉舒张功能；HTK液对血管内皮有明显保护作用,对大隐静脉舒张功能有明显影响。研究目的探讨不同浓度乳化异氟醚对人离体大隐静脉桥舒张功能影响。研究方法取材于临床冠状动脉旁路移植术剩余的成人新鲜大隐静脉。采用器官槽法,分别检测用重碳酸盐缓冲液(KH液)及含1mmol／L乳化异氟醚,2mmol／L乳化异氟醚和5mmol／L乳化异氟醚的重碳酸盐缓冲液浸泡血管环1h后,再用7μml／L indomethacin和300nmol／L LNNA作用后,检测30 nmol／L U46619及不同浓度A23187引发的血管收缩舒张反应。研究结果U46619引发的血管环预收缩强度,各组间差别无显著性差异(P>0.05)；A23187引起的内皮源性舒张,重碳酸盐缓冲液(KH液)及含1mmol／L乳化异氟醚,2mmol／L乳化异氟醚三组间无显著性差异(P>0.05),含5mmol／L乳化异氟醚的重碳酸盐缓冲液组与其余三组间有显著性差异(P<0.01)；电镜下,含5mmol／L乳化异氟醚的重碳酸盐缓冲液对内皮损伤最重,其余三组损伤基本一致。结论1mmol／L乳化异氟醚对血管内皮无明显损伤作用,不影响大隐静脉舒张功能；高浓度乳化异氟醚对血管内皮有明显损伤作用,对大隐静脉舒张功能有明显影响。研究目的探讨人体外循环(CPB)血清诱致培养人血管内皮细胞ICAM-1表达及乳化异氟醚对其影响。研究方法采用CPB血清致伤培养血管内皮细胞模型,以免疫组化方法观察培养血管内皮细胞ICAM-1表达量。研究结果各组血管内皮细胞ICAM-1的表达随着时间的延长均呈进行性升高。各时段小牛血清(FBS)组血管内皮细胞ICAM-1表达量最低(P<0.01)。与CPB前血清组相比,CPB后血清组及乳化异氟醚组1h、2h、4h、8h、12h时的ICAM-1表达水平显著升高(P<0.01)。乳化异氟醚组在1h、2h、4h、8h升高的幅度与CPB后血清组相比明显减少(P<0.01),在12h时的ICAM-1表达水平与CPB后血清组相比无显著性差异(P>0.05)结论CPB显著增加ICAM-1的表达,乳化异氟醚在一定时间内可显著减轻CPB对内皮细胞的影响,减少ICAM-1的表达,对于体外循环后全身炎症反应可能有保护作用。更多还原

【Abstract】 ObjectiveTo investigate the cardioprotective effects of emulsified isofluane on ischemia-reperfusion injury in isolated rat heart.Methods32 Sprague-Dawley rats were randomly divided into the following four groups:control group one with STH solution(group B); control group two with 30%Intralipid (group C); high-dose group with emulsified isoflurane 5mmol/1(group A); low-dose group with emulsified isoflurane lmmol/1(group D). Every group were reperfused 60 min at 37℃after these hearts stopped beating and were stopped perfusing for 60min. Left ventricular development pressure(LVDP), maximum rate of pressure increase, minimum rate of pressure decrease (dp/dtmin), coronary flow (CF), myocardial organize was obtained and myocardial ultrastructure were examined under electronic microscope.ResultsThe concentrations of MDA、cTnI in group C and D were much lower than those of control groups (P<0.01). The LVDP were strengthened obviously in group C and D. The concentrations of MDA、cTnI in group A was much highter than other groups (P<0.01). The myocardial ultrastructural changes were significant in these four groups, there were significant edema and severe damage in myocardium in group A;but there was not so severe in group C and group D.ConclusionLow-dose emulsified isoflurane strengthened cardioprotection solution have advantage effect on ischemia-reperfusion injury in isolated rat heart. ObjectiveTo investigate the effect of emulsified isoflurane on the human siaphena vessel graft during the coronary artery bypass grafting.MethodsA fresh saphenous vein obtained from CABG was cut into 2 mm long rings. The rings were randomly divided into four groups. The tension of the vessel rings was studied by the organ chamber technique. These rings were incubated for 1 hour in aerobic Krebs-Herseleit solution(KH); KH with lmmol/1 emulsified isoflurane; KH with intralipid and HTK. The contraction response from 30 nmol/L U46619 and the relaxation response from A23187 were assessed in presence of 7μmol /L indomethacin and 300nmol/L LNNAResultsThe contraction responses from U46619 were almost same among these four groups. Compared with other three groups, the relaxation response from A23187 in group HTK was significant different. Sightly ultrastructral damage was also found in group HTK.Conclusionlmmol/1 emulsified isoflurane would not damage endothelial cells and weak the relaxation response of the saphena vessel significantly. ObjectiveTo investigate the effect of different concentration of emulsified isoflurane on the human siaphena vessel graft during the coronary artery bypass grafting.MethodsA fresh saphenous vein obtained from CABG was cut into 2 mm long rings. The rings were randomly divided into four groups. The tension of the vessel rings was studied by the organ chamber technique. These rings were incubated for 1 hour in aerobic Krebs-Herseleit solution(KH); KH with 1mmol/Lemulsified isoflurane; KH with 2mmol/L emulsified isoflurane and KH with 5mmol/L emulsified isoflurane. The contraction response from 30 nmol/L U46619 and the relaxation response from A23187 were assessed in presence of 7μmol/L indomethacin and 300nmol/L LNNAResultsThe contraction responses from U46619 were almost same among these four groups. Compared with other three groups, the relaxation response from A23187 in group KH with 5mmol/L emulsified isoflurane was significant different. Significant ultrastructral damage was also found in group KH with 5mmol/L emulsified isoflurane.ConclusionHigh concentration emulsified isoflurane would damage endothelial cells and weak the relaxation response of the saphena vessel significantly. ObjectiveTo observe the effect of Emulsified isoflurane on the changes of ICAM-1 expression induced by CPB serum cultured endothelial cells.METHODSICAM-1 expression on cultured endothelial cells was detected by immunohistochemical method.ResultsICAM-1 expression on cultured endothelial cells was increased in every group. ICAM-1 expression in group FBS was the lowest in four groups (P<0.01). ICAM-1 expression in group post-CPB serum and group Emulsified isoflurane was higher than group pre-CPB (P<0.01). ICAM-1 expression in group Emulsified isoflurane was lower than group post-CPB in 1h,2h,4h and 8h. ICAM-1 expression was almost the same between group Emulsified isoflurane and group post-CPB in 12h(P>0.05).ConclusionEmulsified isoflurane could inhibit ICAM-I expression on cultured endothelial cells and might play a role in decreasing systemic inflammatory response syndrome induced by CPB.更多还原