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目的:评价卡维地洛防治猪急性心肌梗死(AMI)再灌注后无再流的作用.方法:将中华小型猪24只随机分成对照组、卡维地洛组1mg/(kg·d)和假手术组,每组8只.冠状动脉结扎3h,松解1h制备AMI再灌注模型.AMI前、后和再灌注后均行血流动力学测定和心肌声学造影(MCE)检查,最终行病理学分析.结果:①与AMI前相比,对照组AMI后3h主动脉收缩和舒张压(SBP和DBP)、左室收缩压(LVSP),心排量(CO)和左心室内压最大收缩和舒张变化速率(±dp/dtmax)均显著下降(P<0.05),肺毛细血管楔压(PCWP)和左室舒张末压(LVEDP)均显著升高(P<0.01);再灌注后1h仅LVSP显著恢复(P<0.05),±dp/dtmax继续显著下降(P<0.05);而卡维地洛组AMI后3h各项指标变化与对照组相同;但再灌注后1hLVSP,LVEDP,±dp/dtmax和CO均显著恢复(P<0.05)且比对照组更显著(P<0.05).②对照组MCE和病理染色所测的冠脉结扎区心肌范围(LA)高度一致,再灌注后无再流面积(ANR)分别为78.5%和82.3%,心肌坏死面积(NA)占LA的98.5%;而卡维地洛组%LA虽与对照组相当,但两方法所测ANR仅分别为24.9%和25.8%,NA仅为74.4%,均显著小于对照组(P<0.05).③对照组再灌注即刻和再灌注后1h冠脉血流量仅占AMI前的45.8%和50.6%(P<0.01),而卡维地洛组冠脉血流量分别提高到70.6%和74.1%,均比对照组显著增加(P<0.01).结论:卡维地洛能有效地防治AMI再灌注后无再流,改善其心功能,缩小梗死面积.
Objective: To evaluate the effect of carvedilol on preventing no-reflow after acute myocardial infarction (AMI) reperfusion.Methods: Twenty-four Chinese miniature pigs were randomly divided into control group, carvedilol group, 1mg / (kg · d) Sham-operation group, with 8 rats in each group.The model of AMI reperfusion was prepared by ligation of coronary artery for 3h and release for 1h.The hemodynamics and myocardial contrast echocardiography (MCE) before and after AMI, Results: ① Compared with before AMI, systolic and diastolic blood pressure (SBP and DBP), left ventricular systolic pressure (LVSP), cardiac output (CO), and maximal left ventricular pressure (P <0.05), and pulmonary capillary wedge pressure (PCWP) and left ventricular end diastolic pressure (LVEDP) were significantly increased (P <0.01); 1h after reperfusion (P <0.05), but the ± dp / dtmax continued to decrease significantly (P <0.05), while the change of 3h after carrageenan group was the same as that of the control group. However, the changes of LVSP, LVEDP, dp / dtmax and CO both recovered significantly (P <0.05), and were more significant than those in the control group (P <0.05) .②The myocardial area (LA) in the coronary artery ligation zone measured by MCE and pathological staining in the control group was highly consistent No reflow area (AN R were 78.5% and 82.3%, respectively. The area of myocardial necrosis (NA) accounted for 98.5% of LA. The% LA in carvedilol group was similar to that in control group, but the ANR measured by the two methods were only 24.9% and 25.8% , NA was only 74.4%, which were significantly lower than those in the control group (P <0.05) .③Compared with the control group, the coronary blood flow at 1h after reperfusion was only 45.8% and 50.6% (P <0.01) Carvedilol group coronary blood flow increased to 70.6% and 74.1%, respectively, than the control group was significantly increased (P <0.01) .Conclusion: Carvedilol can effectively prevent and treat AMI without reperfusion after reperfusion to improve its Heart function, reduce infarct size.