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目的:经导管建立冠状动脉微栓塞模型,测定微栓塞后冠脉血流储备及心肌血流量的变化情况,并探讨其机制。方法:12只小型猪,通过导管方法建立急性冠脉微栓塞模型,观察急性期(基础、微栓塞后2h、6h)及慢性期(基础、微栓塞后1周)冠脉血流储备和心肌血流量的变化情况,并测定血清中内皮素-1(ET-1)浓度变化。结果:急性期冠脉微栓塞后冠脉血流储备在基础、微栓塞后2h、6h分别为2.10±0.60、1.40±0.10及1.10±0.10(微栓塞后2h及6h与基础相比,均P<0.01),慢性期实验中,冠脉血流储备在微栓塞前及微栓塞后1周分别为2.03±0.43及1.58±0.22(微栓塞后1周与基础相比,P<0.05)。但前内侧和后内侧心肌血流量以及它们的比值在微栓塞后没有显著变化。测定血清ET-1浓度显示微栓塞后2h开始升高,但只有微栓塞后6h较基础有明显增加(P<0.05),微栓塞后6h及1周心脏标本NBT染色均未见梗死灶。结论:冠脉微栓塞后冠脉血流储备呈现先下降后恢复的趋势,这种变化与内皮功能变化一致,冠脉血流储备和心肌血流量变化不同步。
OBJECTIVE: To establish a coronary micro-embolization model by catheterization to determine changes of coronary flow reserve and myocardial blood flow after micro-embolization and to explore its mechanism. Methods: Acute coronary micro-embolism models were established by catheterization in 12 miniature pigs. Coronary flow reserve and myocardium were observed in acute phase (basal, 2h, 6h after micro-embolism) and chronic phase (basal, 1 week after micro-embolization) Blood flow changes, and determination of serum endothelin-1 (ET-1) concentration changes. Results: Coronary flow reserve after acute coronary micro-embolization was 2.10 ± 0.60, 1.40 ± 0.10 and 1.10 ± 0.10 at 2h and 6h after micro-embolization (P> <0.01). In the chronic phase, the coronary flow reserve was 2.03 ± 0.43 and 1.58 ± 0.22 respectively before micro-embolization and 1 week after micro-embolization (1 week after micro-embolism, P <0.05). However, there was no significant change in the anteromedial and posterior medial myocardial blood flow and their ratio after micro-embolization. The concentration of ET-1 in serum showed that the level of ET-1 began to increase 2h after micro-embolization, but only increased significantly 6h after micro-embolization (P <0.05). No infarction was found in NBT of 6h and 1 week after micro-embolization. CONCLUSIONS: Coronary flow reserve tends to decrease first and then resume after coronary micro-embolization. This change is consistent with the change of endothelial function. The changes of coronary flow reserve and myocardial blood flow are not synchronized.