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目的制备家猪急性心肌梗死模型,探讨梗死相关冠状动脉流量储备分数和零血流压对与存活心肌的评价作用。方法用普通家猪13只,麻醉后行冠状动脉造影,造影结束后应用指引导管测量主动脉内压力,置入冠状动脉内压力导丝测量前降支远端冠状动脉内的压力,计算流量储备分数(FFR);置入冠状动脉内多普勒导丝测量前降支远端冠状动脉内的血流速度,绘制压力-血流速度坐标轴,计算零血流压(Pzf)。将冠状动脉成形术球囊送至冠状动脉左前降支中远端,堵闭血流60～100min,建立家猪心肌梗死模型。模型建立后重复测量计算FFR及Pzf,观察梗死前后FFR及Pzf的变化。处死实验动物,采用TTC染色法识别梗死心肌与存活心肌,通过图像分析仪计算存活心肌占整个左心室容积的百分数,观察其与梗死后前降支Pzf数值之间的关系。结果所有家猪均完成冠状动脉左前降支远端的封堵,2只猪分别在堵闭45和65min时因心室纤颤死亡。存活11只家猪成功地建立急性心肌梗死模型。模型制备后前降支FFR数值均小于0.75,较梗死前降低(P<0.001)。模型制备后前降支Pzf数值较梗死前升高(P<0.001)。梗死后前降支Pzf数值随存活心肌占左心室心肌百分数升高而降低,二者呈负相关。结论运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗死模型,梗死相关血管FFR数值小于0.75可以作为检出存活心肌的标准,Pzf数值的测定可以作为预测心肌梗死后存活心肌范围的一个指标。
Objective To prepare a model of acute myocardial infarction (AMI) in domestic pigs and investigate the evaluation of myocardial infarction-related coronary flow reserve score and zero pressure on the evaluation of viable myocardium. Methods Thirteen ordinary domestic pigs were anesthetized and underwent coronary angiography. After the end of angiography, the guide catheter was used to measure the intra-aortic pressure. The coronary pressure catheter was placed in the distal coronary artery to measure the flow reserve Score (FFR). The coronary arteries were implanted with Doppler guide wire to measure the velocity of blood flow in the distal coronary artery. The pressure-blood flow velocity axis was plotted to calculate the zero blood pressure (Pzf). The coronary angioplasty balloon to the left anterior descending coronary artery distal, blocking the flow of 60 ~ 100min, the establishment of domestic pig myocardial infarction model. After establishing the model, FFR and Pzf were calculated repeatedly, and the changes of FFR and Pzf before and after infarction were observed. The experimental animals were sacrificed and the myocardial infarction and viable myocardium were identified by TTC staining. The percentage of viable myocardium to the total left ventricular volume was calculated by image analyzer, and the relationship between Pzf and the Pzf value of anterior descending artery was observed. Results All domestic pigs completed the distal occlusion of the left anterior descending coronary artery. Two pigs died of ventricular fibrillation at 45 and 65 min after occlusion. Eleven pigs survived successfully established acute myocardial infarction model. The FFR of anterior descending branch of the model were all less than 0.75 and lower than before infarction (P <0.001). The Pzf value of anterior descending artery after model preparation was higher than that before infarction (P <0.001). The Pzf value of the anterior descending artery after infarction decreased with the percentage of viable myocardium in the left ventricular myocardium, which was negatively correlated. Conclusion Percutaneous transluminal coronary angioplasty balloon occlusion of coronary artery can be successfully established in pig acute myocardial infarction model, infarct-related vascular FFR value of less than 0.75 can be used as a standard for detection of viable myocardium, Pzf value can be used as a prediction of myocardial infarction An indicator of the range of surviving myocardium.