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实验性缺血再灌注心肌顿抑与一氧化氮的关系及东莨菪碱对其影响 |
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m were taken for MDA content assay and cardiac performance was measured at the corresponding
time points. Results Concentrations of NO, CK, cGMP and myocardial MDA content increased
significantly in group I at time B and C, as compared with time A (P〈0.05—0.001) and the same
time points in group Ⅱ (P〈0.05—0.01). Parameters of cardiac funciton were found to be decreased
in both groups but more significant decrease was found in group I than in group Ⅱ. There was positive
correlation between the changes of NO and myocardial MDA content or CK (P〈0.005 and P〈0.01,
respectively) after reperfusion. Conclusion The excessive production of NO during reperfusion may
contribute to myocardial stunning. The marked increase of NO was deleterious to cardiac function
by increasing myocardial cGMP and peroxidizing the myocyte membrane lipid. The beneficial influence
of scopolamine by reducing the production of NO and improving the function of stunned myocardium
was related to its effects of preventing myocardial cell lipid peroxidation.
【Key words】 myocardial stunning nitric oxide scopolamine
近来研究表明，再灌注过程产生的大量一氧化氮(NO)与心肌功能损害有密切关
系［1］。本实验在体外循环心肌缺血再灌注模型上观察心肌功能的改变与NO的关系，
进一步研究心肌顿抑的机制，并探讨东莨菪碱治疗的作用。
材料与方法
12只绵羊，体重37～43 kg，雌雄不拘，随机分为对照组(Ⅰ组，n=6)和东莨
菪碱治疗组(Ⅱ组，n=6)。静脉全麻后，气管切开插管连接呼吸机(Aika clv 50,
Japan)。左颈内动脉插管测压。胸骨正中切口进胸，心尖部置管经换能器连接至
SJ-42多道生理记录仪监测左心室压力变化参数。采用POLYSTAN HERLEN DENMARK
人工心肺机，西京87型鼓泡式氧合器，常规建立体外循环。主动脉阻断同时在其
根部灌注仁济医院心停搏液，其成分(mmol/L)：KCl 20，MgCl2 21，NaCl 51，
NaHCO3 9，Glucose 151,Procaine 2.2。Ⅰ组，仁济医院停搏液10 ml/kg；Ⅱ组，
在停搏液中加入东莨菪碱17.5 μg/kg。心脏停搏60分钟，期间维持鼻咽温度28℃、
心肌温度15℃左右，灌注压6.67 kPa(1kPa=7.5mmHg)左右，动脉血氧分压20～30 kPa。
阻断30分钟时再次以停搏液5 ml/kg灌注心肌，Ⅱ组加入同前剂量药物。
分别于主动脉阻断前、再灌注5分钟、再灌注30分钟取冠状窦血标本、左心
室心肌标本，并于相应时点记录平均动脉压(MAP)、左室收缩压(LVSP)、左室舒
张末压(LVEDP)、左室压力上升最大速率(+dp/dtmax)及左室压力下降最大速率
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