Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Anesthesiology. 2013 Jun;118(6):1385-94. doi: 10.1097/ALN.0b013e31828744c0.
Xenon and isoflurane are known to have cardioprotective properties. We tested the hypothesis that these anesthetics positively influence myocardial remodeling 28 days after experimental perioperative myocardial infarction and compared their effects.
A total of 60 male Sprague-Dawley rats were subjected to 60 min of coronary artery occlusion and 120 min of reperfusion. Prior to ischemia, the animals were randomized for the different narcotic regimes (0.6 vol% isoflurane, 70 vol% xenon, or intraperitoneal injection of s-ketamine). Acute injury was quantified by echocardiography and troponin I. After 4 weeks, left ventricular function was assessed by conductance catheter to quantify hemodynamic compromise. Cardiac remodeling was characterized by quantification of dilatation, hypertrophy, fibrosis, capillary density, apoptosis, and expression of fetal genes (α/β myosin heavy chains, α-skeletal actin, periostin, and sarco/endoplasmic reticulum Ca2+-ATPase).
Whereas xenon and isoflurane impeded the acute effects of ischemia-reperfusion on hemodynamics and myocardial injury at a comparable level, differences were found after 4 weeks. Xenon in contrast to isoflurane or ketamine anesthetized animals demonstrated a lower remodeling index (0.7 ± 0.1 vs. 0.9 ± 0.3 and 1.0 ± 0.3g/ml), better ejection fraction (62 ± 9 vs. 49 ± 7 and 35 ± 6%), and reduced expression of β-myosin heavy chain and periostin. The effects on hypertrophy, fibrosis, capillary density, and apoptosis were comparable.
Compared to isoflurane and s-ketamine, xenon limited progressive adverse cardiac remodeling and contractile dysfunction 28 days after perioperative myocardial infarction.
氙气和异氟烷已知具有心脏保护作用。我们检验了这样一个假说，即在实验性围术期心肌梗死 28 天后，这些麻醉剂会积极影响心肌重构，并比较它们的作用。
共 60 只雄性 Sprague-Dawley 大鼠接受 60 分钟的冠状动脉闭塞和 120 分钟的再灌注。在缺血之前，动物被随机分配到不同的麻醉方案（0.6 体积%异氟烷、70 体积%氙气或腹腔注射 s-氯胺酮）。通过超声心动图和肌钙蛋白 I 定量急性损伤。4 周后，通过传导导管评估左心室功能，以量化血流动力学损伤。通过扩张、肥大、纤维化、毛细血管密度、细胞凋亡和胎儿基因（α/β肌球蛋白重链、α-骨骼肌肌动蛋白、骨膜蛋白和肌浆/内质网 Ca2+-ATP 酶）的表达来描述心肌重构。
尽管氙气和异氟烷在可比水平上阻碍了缺血再灌注对血流动力学和心肌损伤的急性影响，但在 4 周后发现了差异。与异氟烷或氯胺酮麻醉的动物相比，氙气麻醉的动物表现出较低的重构指数（0.7±0.1 比 0.9±0.3 和 1.0±0.3g/ml）、更好的射血分数（62±9 比 49±7 和 35±6%）和β-肌球蛋白重链和骨膜蛋白表达降低。肥大、纤维化、毛细血管密度和细胞凋亡的影响相当。
与异氟烷和 s-氯胺酮相比，氙气在围术期心肌梗死后 28 天限制了进行性不良的心脏重构和收缩功能障碍。
