Chen Guo-zhong, Wang Qing-xiang, Wu Xiao-zhi, Liu Ren, Jiang He-qun
Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China. Email:
Zhonghua Yi Xue Za Zhi. 2009 Dec 22;89(47):3366-70.
To investigate the effect of high thoracic epidural anesthesia on ventricular remodeling and cardiac function in rats with heart failure induced by myocardial infarction, and to investigate their mechanism.
Rats that had been established successively model were randomly divided into S group (n = 12), HTEA group and CHF group (24/group). 9.0 g/L normal sodium 100 microl/kg was injected to epidural cavity twice a day separately in group S and group CHF. 1.25 g/L bupivacaine 100 microl/kg was injected to epidural cavity twice a day in group HTEA. Epidural injection was started 24 hrs after the epidural surgery and continued 4 weeks. Then the change of cardiac function was observed by using echocardiogram. The ratio of heart weight to body weight (HW/BW) and the ratio of left ventricular weight to body weight (LVW/BW) were measured. Noninfarct ventricular tissue were stained with hematoxylin-eosin (HE) and Masson's trichrome respectively. beta(3)-adrenoceptor levels and eNOS levels were detected with reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry.
LVEDD and LVESD were significantly decreased in the group HTEA compared with group CHF (P < 0.01), while LVEF% and LVFS% were significantly increased (P < 0.01). The ratios HW/BW and LVW/BW were significantly increase in the group CHF compared with the group S (P < 0.01), but they were limited in the group HTEA (P < 0.01). Hypertrophy and edema, degeneration and necrosis of myocytes can be seen in rats with CHF, as well as muscle fibers disruption and collagen fiber increase, while the pathological amorphous were attenuated in HTEA rats. beta(3)AR and eNOS mRNA levels were significantly decreased in the group THEA compared with the group CHF.
These results indicate that HTEA could ameliorate ventricular remodeling and cardiac function in rats with heart failure induced by myocardial infarction. The mechanism could involve decreases of beta(3)AR expression in rats of heart failure.
探讨高胸段硬膜外麻醉对心肌梗死所致心力衰竭大鼠心室重构及心功能的影响，并探讨其机制。
将成功建立模型的大鼠随机分为S组（n = 12）、高胸段硬膜外麻醉组（HTEA组）和慢性心力衰竭组（CHF组，每组24只）。S组和CHF组每天两次向硬膜外腔分别注射9.0 g/L生理盐水100 μl/kg。HTEA组每天两次向硬膜外腔注射1.25 g/L布比卡因100 μl/kg。硬膜外手术后24小时开始硬膜外注射，持续4周。然后用超声心动图观察心功能变化。测量心脏重量与体重之比（HW/BW）和左心室重量与体重之比（LVW/BW）。非梗死心室组织分别用苏木精-伊红（HE）染色和马松三色染色。用逆转录-聚合酶链反应（RT-PCR）和免疫组织化学检测β3-肾上腺素能受体水平和内皮型一氧化氮合酶（eNOS）水平。
与CHF组相比，HTEA组左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）显著降低（P < 0.01），而左室射血分数（LVEF%）和左室短轴缩短率（LVFS%）显著升高（P < 0.01）。与S组相比，CHF组HW/BW和LVW/BW显著升高（P < 0.01），但HTEA组升高受限（P < 0.01）。CHF大鼠可见心肌细胞肥大、水肿、变性和坏死，以及肌纤维断裂和胶原纤维增加，而HTEA大鼠的病理改变减轻。与CHF组相比，HTEA组β3肾上腺素能受体（β3AR）和eNOS mRNA水平显著降低。
这些结果表明，高胸段硬膜外麻醉可改善心肌梗死所致心力衰竭大鼠的心室重构和心功能。其机制可能与心力衰竭大鼠β3AR表达降低有关。
