| Myocardial ischemia reperfusion injury (MIRI) has become an importantissue in clinical cardiology with the increase of coronary heart disease andreperfusion therapy associated with it in recent years. MIRI means thefurther damage at myocardial ultrastructure, electrophysiological aspects,function and metabolism due to the energy metabolism disorder, a lot offree radicals, calcium overload after ischemic myocardium restores bloodflow. This reperfusion injury, which can lead to myocardial andmicrovascular function stunning, arrhythmia and myocardial infarction, hasserious impact on the recovery of cardiac function after ischemia, andendanger the patient’s life. It has been an important topic in cardiovascularresearch on how to reduce MIRI by effective means. Currently, a series ofstudies in domestic and abroad have showed that ischemic postconditioning and pharmacologic post conditioning are two majorprotections against MIRI. Ischemic post conditioning (IPOC) refers torepeating transient ischemia/reperfusion (I/R) treatment several timesimmediately after ischemic myocardia blood restoration reperfusion, it canimprove the tolerance of myocardial long time I/R, thus reducing MIRI.Pharmacologic post conditioning (PPOC) is a new proposed concept, itrefers that drugs can play a protective role for MIRI given at differentintervention time (reperfusion period or after reperfusion), it has the sameprotective effect on myocardial I/R injury.Fentanyl is a commonly used opioids in clinic. The study of Wuqiao Linghas showed that Fentanyl post conditionin can interfer the open of Ca2+ channel, reduce intracellular calcium overload and the generation of freeradical, inhibite cell apoptosis by upregulating the expression ofanti-apoptotic protein B-cell lymphoma/leukemia2gene (Bcl-2) anddownregulating the expression of pro-apoptotic protein Bcl-2associated xprotein (Bax), thus reducing myocardial ischemia-reperfusion injury.654-2as an anticholinergic drug is also called anisodamine. Studies haveshown that Anisodamine can reduce ischemia-reperfusion injury byrelieving vasospasm and also by improving slow flow phenomenon duringthe percutaneous coronary intervention. Another study has showed thatAnisodamine can significantly reduce the incidence of reperfusionarrhythmias, hypotension and slow blood flow by inhibiting oxygen freeradicals and improving microcirculation and so on.Our study was to ligate the left anterior descending coronary artery (LAD)30min and reperfusion120min minutes to establish myocardialischemia-reperfusion model of rabbits. The48Japanese white rabbits wererandomly assigned to six groups (n=8each): Sham-operated group (groupS), ischemia-reperfusion group (group I/R), ischemic post conditioninggroup (group IPOC), ischemic and fentanyl post conditioning group (groupIPOC+F), ischemic and anisodamine post conditioning group (groupIPOC+654-2), ischemic joint with fentanyl and anisodamine postconditioning group (group IPOC+F+654-2). The rabbits were givendifferent post-processing methods accordingly: group S, the LADseparation without ligation; group I/R, direct restoring reperfusion; groupIPOC, after30min′s ischemia, ischemic post conditioning (filling for30s/ischemia for30s, three rounds) methods and then restoring reperfusion;group IPOC+F, group IPOC+654-2and group IPOC+F+654-2, ischemia28min by ear marginal vein respectively to different doses of fentanyl and654-2, two different kinds of drugs for pharmanic post-processing, andafter30min, ischemic post conditioning then restoring reperfusion. By detecting the different indexes like the incidence of arrhythmia, thehemodynamic, the myocardial infarct size, the myocardial necrosis markerssuch as the active concentration of Creatine kinase enzyme protein and theconcentration of cardiac troponin I, the metabolism markers such as theactive concentration of superoside dismutase and the concentration ofmanlondialdehyde, to find the difference between two kinds of PPOCcombined with IPOC and one kind of PPOC combined with IPOC inmyocardial I/R injuiry protection.The results showed that the myocardial infarct size of groupIPOC+F+654-2was lower than the group IPOC+F and the groupIPOC+654-2. The myocardial infarct size of group IPOC+654-2and groupIPOC+F was lower than the group IPOC (P <0.05or P <0.01), but thehemodynamic and incidence of arrhythmia level had no significantdifference between groups. Group IPOC+654-2and group IPOC+F had nosignificant difference in the index above.In summary, myocardial ischemia post conditioning combined withfentanyl and anisodamine for the treatment of myocardial reperfusioninjury both have a protective effect, but these two drugs combined withischemia post conditioning have a greater protective effect than the onlyone kind of these two drugs combined with ischemia post conditioning. |
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