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目的评价腺苷防治猪急性心肌梗死(AMI)再灌注后无再流的作用。方法中华小型猪24只随机分成对照组、腺苷组(100μg·kg-1·min-1持续静点)和假手术组,每组8只。前2组行冠状动脉结扎3h,松解1h建立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、左室收缩压、心排量和左室内压最大收缩和舒张变化速率(±dp/dtmax)均显著下降(P<0.05～0.01),肺毛细血管楔压和左室舒张末压均显著升高(P<0.01);再灌注后1h仅左室舒张末压显著恢复(P<0.05)然而±dp/dtmax继续显著下降(P<0.05);而腺苷组AMI后3h各项指标变化与对照组相同;但再灌注后1h左室收缩压、左室舒张末压、±dp/dtmax和心排量均显著恢复(P均<0.05),且比对照组更显著(P均<0.05)。(2)对照组心肌声学造影和病理染色所测的冠状动脉结扎区心肌范围高度一致,再灌注后无再流面积分别为67.5%和69.3%,心肌坏死面积(NA)占结扎区心肌面积(LA)的98.5%;而腺苷组LA均与对照组相当,但两方法所测无再流面积仅分别为21.5%和20.8%,NA仅为75.2%,均显著小于对照组(P<0.05～0.01)。(3)对照组再灌注即刻和再灌注后1h冠状动脉血流量仅占AMI前的45.8%和50.6%(P均<0.01),而腺苷组冠
Objective To evaluate the effect of adenosine on preventing no-reflow after acute myocardial infarction (AMI) reperfusion in pigs. Methods 24 Chinese miniature pigs were randomly divided into control group, adenosine group (100μg · kg-1 · min-1) and sham operation group (n = 8). The first two groups of coronary artery ligation 3h, release 1h AMI reperfusion model. Hemodynamic and myocardial contrast echocardiography were performed before and after AMI and after reperfusion, and finally pathological analysis was performed. Results (1) Compared with those before AMI, systolic and diastolic blood pressure, left ventricular systolic pressure, cardiac output and maximal left ventricular pressure and diastolic velocity (± dp / dtmax) were significantly decreased 3h after AMI in control group P <0.05-0.01), and pulmonary capillary wedge pressure and left ventricular end-diastolic pressure were significantly increased (P <0.01); only left ventricular end-diastolic pressure was significantly recovered 1h after reperfusion (P <0.05) (P <0.05). In the adenosine group, the changes of indexes at 3h after AMI were the same as those in the control group. However, the left ventricular systolic pressure, left ventricular end-diastolic pressure, ± dp / dtmax and cardiac output at 1h after reperfusion (P <0.05), and more significantly than the control group (all P <0.05). (2) The myocardium extent of coronary artery ligation zone measured by myocardial contrast echocardiography and pathological staining in control group were highly consistent. The area of no-reflow after reperfusion was 67.5% and 69.3%, respectively. The area of myocardial necrosis (NA) (P <0.05), while LA of adenosine group was similar to that of control group, but no reflux area measured by two methods was only 21.5% and 20.8%, NA was only 75.2%, which were significantly lower than that of control group ~ 0.01). (3) Coronary artery blood flow immediately after reperfusion and at 1 hour after reperfusion in control group accounted for only 45.8% and 50.6% of those before AMI (P <0.01), while adenosine group