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目的应用选择性冠状动脉前降支(LAD)球囊闭塞结合微血栓微球混悬液灌注方法造成心肌缺血坏死,探索建立稳定存活的小型猪急性心肌梗死(AMI)后心力衰竭(HF)动物模型。方法选择中国五指山小型猪18头,行冠脉造影后沿血管送球囊至LAD中段,依次扩张球囊阻断前向血流1、2、5 min,每次间隔60 s,然后扩张球囊堵闭血流120 min。再以4F导管超选LAD,行微血栓微球混悬液分次注入,间隔10 min重复注射,TIMI心肌灌注分级(TMPG)<2级和左室舒张末压(LVEDP)>15 mm Hg时停止注射,同时监测心电图及应用漂浮导管监测有创血流动力学参数。并行pigtail导管测量(LVEDP)的变化,待LVEDP稳定在15~18 mm Hg之间后结扎血管,并加压包扎。监测心肌坏死标志物(cTnI和CK-MB)变化。分别于制模前,制模后第1天、7天、14天行心脏超声检查,制模第14天复查有创血流动力学检查,并行心脏病理检查,认定和评价模型的成功率、稳定性和可重复性。结果制模14 d后共有15头小型猪成活,心电图、心肌坏死标记物、病理检查均符合AMI病理生理过程。其中14头小型猪达到动物模型标准【肺毛细血管楔压(PCWP)>18 mmHg和心输出量(CO)下降30%以上】,模型成功率为77.78%。制模后第14天PCWP明显升高(P<0.01),CO平均下降50.76%;左室射血分数(LVEF)明显降低(P<0.01)。病理检查显示心肌梗死面积占左心室面积的25.4%~34.9%。结论球囊闭塞结合微血栓微球混悬液灌注构建小型猪急性心肌梗死后心力衰竭模型具有闭胸、高成功率、稳定和重复性好等优点,较药物、冠状动脉结扎和起搏诱导的心力衰竭模型更接近临床病理生理学特点。
Objective To establish myocardial ischemia and necrosis by selective balloon occlusion of LAD and suspension infusion of microthrombus microspheres, and to explore the establishment of a stable surviving small pig acute myocardial infarction (AMI) after heart failure (HF) Animal model Methods 18 Chinese Wuzhishan miniature pigs were selected. After coronary angiography, the balloon was delivered to the middle of the LAD through the vessels. The balloon was sequentially dilated to block the anterior cerebral blood flow for 1, 2 and 5 min, with an interval of 60 s. The balloon was then dilated Clogged blood flow 120 min. Then, 4F catheter was used to select the LAD, and the micro-thrombus suspension was injected subcutaneously at intervals of 10 min with TIMI myocardial infarction (LVEDP)> 15 mm Hg The injection was stopped while the electrocardiogram was monitored and the invasive hemodynamic parameters were monitored using a floating catheter. Parallel pigtail catheter measurements (LVEDP) changes, until LVEDP stabilized at between 15 ~ 18 mm Hg after ligation of blood vessels, and pressure dressing. Changes in markers of myocardial necrosis (cTnI and CK-MB) were monitored. Cardiac echocardiography was performed on the first day, seven days and fourteen days after the model was made. The hemodynamic examination was performed on the fourteenth day after the model was made. The success rate of the model was confirmed and evaluated. Stability and repeatability. Results A total of 15 piglets survived 14 days after modeling. The electrocardiogram and myocardial necrosis markers and pathological examination were consistent with AMI pathophysiological process. Fourteen piglets reached the animal model standard [pulmonary capillary wedge pressure (PCWP> 18 mmHg and cardiac output (CO) decreased by more than 30%], the model success rate was 77.78%. On the 14th day after modeling, the PCWP was significantly increased (P <0.01), the average CO decreased by 50.76%, and the left ventricular ejection fraction (LVEF) was significantly decreased (P <0.01). Pathological examination showed myocardial infarction area accounted for 25.4% of left ventricular area 34.9%. Conclusion balloon occlusion combined with micro-suspension infusion of microthrombi in mini-swine heart failure model after acute myocardial infarction with closed chest, high success rate, stability and good repeatability, compared with drugs, coronary artery ligation and pacing induced Heart failure model is closer to clinical pathophysiology.