Department of Anesthesia and Intensive Care, Aarhus University Hospital, Skejby, Denmark.
Acta Anaesthesiol Scand. 2012 Jan;56(1):57-65. doi: 10.1111/j.1399-6576.2011.02580.x. Epub 2011 Nov 21.
Sevoflurane post-conditioning (SePost) has been found to alleviate ischemic myocardial reperfusion injury through the activation of prosurvival kinases. Lowered myocardial oxygen demand from reduced cardiac work may also contribute to cardioprotection, and is much less well-studied. Our aim was to examine the simultaneous effects of SePost on cardiac work (here, rate-pressure product, RPP) and myocardial infarct size in a porcine model.
Anesthetized 25 kg pigs were randomly allocated to two groups and underwent 45 min regional coronary artery balloon occlusion and subsequent 2 h reperfusion. SePost (n = 10) was given as sevoflurane 1.5-3% end-tidal concentration during reperfusion while controls (n = 12) were untreated. Aortic blood pressure was measured directly, while mixed-venous oxygen saturation and cardiac output were measured in the pulmonary artery. Cardiac work was determined as RPP. Post-mortem, histologic myocardial infarct size (IS), and area at risk were determined in transverse heart slices after tetrazolium stain.
Myocardial infarct size was reduced from (control) 55.0 (mean) ± 13.6% (standard deviation) to 32.5 ± 13.4% in group SePost (P = 0.0009). During reperfusion, SePost resulted in lower heart rate (P = 0.0003), cardiac output (P = 0.0123), mixed-venous oxygen saturation (P = 0.0103), blood pressure, and RPP (P < 0.0001). RPP was highly correlated to IS (P = 0.0055).
SePost (1.5-3%) reduced infarct size after regional myocardial ischemia in vivo and reduced cardiac work was significantly correlated to myocardial salvage.
七氟醚后处理（SePost）通过激活生存相关激酶已被证实可减轻缺血再灌注心肌损伤。降低的心肌耗氧量也可能来自减少的心脏工作量，且这种作用研究得较少。我们的目的是在猪模型中研究 SePost 对心脏工作（此处为心率-血压乘积，RPP）和心肌梗死面积的同时影响。
麻醉的 25 公斤猪随机分配到两组，进行 45 分钟区域冠状动脉球囊闭塞和随后 2 小时再灌注。在再灌注期间，SePost 组（n = 10）给予 1.5-3%七氟醚呼气末浓度，而对照组（n = 12）未进行处理。主动脉血压直接测量，混合静脉血氧饱和度和心输出量在肺动脉测量。心脏工作作为 RPP 确定。死后，在四唑染色后，在横向心脏切片中确定组织学心肌梗死面积（IS）和危险区面积。
与对照组（55.0±13.6%）相比，SePost 组的心肌梗死面积减少至 32.5±13.4%（P=0.0009）。在再灌注期间，SePost 导致心率（P=0.0003）、心输出量（P=0.0123）、混合静脉血氧饱和度（P=0.0103）、血压和 RPP（P<0.0001）降低。RPP 与 IS 高度相关（P=0.0055）。
在体内局部心肌缺血后，1.5-3%的 SePost 减少了梗死面积，并且心脏工作的减少与心肌挽救显著相关。
