论文部分内容阅读
背景:至目前为止发表的心肺复苏论文所使用的基本为健康动物,而临床实际情况是在心肺复苏发生之前患者大多有严重的心脏疾病,并导致了心室颤动的发生。目的:实验力图接近临床实际,观察骨髓间充质干细胞移植后心肌梗死大鼠心功能的变化,及对其心肺复苏结果的影响。设计、时间及地点:随机对照动物实验,于2007-04/08在美国南加州大学和中山大学附属第二医院联合完成。材料:成年SD雄性大鼠18只,随机分为模型对照组、细胞移植组,9只/组。另取1月龄SD大鼠1只用于制备骨髓间充质干细胞。方法:两组大鼠均结扎左前降支冠状动脉建立心肌缺血模型,4周后再次开胸,细胞移植组梗死心肌局部注射PKH26荧光标记的骨髓间充质干细胞悬液0.1mL(5×106个细胞),模型对照组同法注射等量PBS。4周时诱导心室颤动及进行心肺复苏。主要观察指标:移植后2,4周用超声心动图测量心功能;测量心肺复苏前及心肺复苏后4h内的血液动力学参数的变化;在心肺复苏72h后取心肌组织进行病理切片检查。结果:与模型对照组比较,移植后2,4周细胞移植组射血分数均明显升高(P<0.01)。在心肺复苏前及心肺复苏后4h内,与模型对照组比较,细胞移植组心脏指数、左心室收缩压力上升到40mmHg(1mmHg=0.133kPa)时的上升速率、左心室舒张速率、左心室舒张末压均有明显改善(P<0.01,P<0.05)。与模型对照组比较,细胞移植组大鼠心肺复苏后可生存至72h,生存时间明显延长(P<0.05)。病理切片结果显示心肌内存在大量PKH26标记的骨髓间充质干细胞。结论:大鼠心肌梗死后,骨髓间充质干细胞移植治疗能明显改善其心功能、心肺复苏前后的血流动力学参数以及生存时间。
BACKGROUND: The basic cardiopulmonary resuscitation papers published so far have been based on healthy animals. The clinical reality is that most patients have severe heart disease before cardiopulmonary resuscitation and lead to ventricular fibrillation. OBJECTIVE: To try to get closer to clinical practice and observe the changes of cardiac function in myocardial infarction rats after bone marrow mesenchymal stem cell transplantation and the effects on cardiopulmonary resuscitation. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the University of Southern California and the Second Affiliated Hospital of Sun Yat-Sen University between April 2007 and August 08. MATERIALS: Eighteen adult SD male rats were randomly divided into a model control group, a cell transplantation group and 9 / group. Another 1-month-old SD rats were used to prepare bone marrow-derived mesenchymal stem cells. METHODS: Myocardial ischemia model was established by ligation of the left anterior descending coronary artery in both groups. After 4 weeks, the model of myocardial ischemia was re-opened. The infarcted myocardium in the cell transplantation group was injected with 0.1 mL of PKH26 fluorescently labeled bone marrow mesenchymal stem cell suspension (5 × 106 Cells), model control group with the same method of injection of PBS. Ventricular fibrillation and cardiopulmonary resuscitation were induced at 4 weeks. MAIN OUTCOME MEASURES: Cardiac function was measured by echocardiography 2, 4 weeks after transplantation. Changes of hemodynamic parameters were measured before cardiopulmonary resuscitation (CPR) and within 4 hours after cardiopulmonary resuscitation (CPR). Cardiac tissues were taken for pathological examination 72 hours after cardiopulmonary resuscitation. Results: Compared with the model control group, the ejection fraction of the cell transplantation group at 2 and 4 weeks after transplantation significantly increased (P <0.01). Before cardiopulmonary resuscitation and within 4 hours after cardiopulmonary resuscitation, compared with the model control group, the cardiac index, the rate of left ventricular systolic pressure increased to 40mmHg (1mmHg = 0.133kPa), the rate of left ventricular diastolic velocity, left ventricular end diastolic pressure Pressure were significantly improved (P <0.01, P <0.05). Compared with the model control group, the survival time of rats in the cell transplantation group survived to 72h after cardiopulmonary resuscitation (P <0.05). The results of biopsy showed that a large number of PKH26-labeled MSCs existed in the myocardium. Conclusion: Bone marrow mesenchymal stem cell transplantation can significantly improve cardiac function, hemodynamic parameters before and after cardiopulmonary resuscitation and survival time after myocardial infarction in rats.