https://scholars.lib.ntu.edu.tw/handle/123456789/188357
標題: | 引發之心包黏連對急性心肌梗塞後左心室重塑之預防作用-動物實驗模式 | 其他標題: | Prevention of left ventricular remodeling after acute myocardial infarction by induction of pericardial adhesion - A porcine model | 作者: | 廖朝崧 | 關鍵字: | 急性心肌梗塞;心室重塑;心包膜粘連;心室拘限;acute myocardial infarction;ventricular remodeling;pericardial adhesion;ventricular containment | 公開日期: | 2004 | 出版社: | 臺北市:國立臺灣大學醫學院內科 | 摘要: | 急性心肌梗塞會導致左心室重塑,可影響左心室之梗塞部位及非梗塞部位。 在心肌梗塞急性期,無法收縮之心室壁極易膨出,擴大,因而引發心室重塑。左 心室重塑可導致臨床上之重要併發症,如心室瘤形成,急性期心臟破裂,再發心 肌缺血,心律不整,以及心衰竭,結果是提早死亡。我們提出一個假說,在急性 心肌梗塞發生後,若能儘速引發心包黏連以拘限左心室,使其不致擴大,應有可 能防止心室重塑。為試驗此一假說,我們進行了本實驗。 共有36 隻豬,七隻肉豬,29 隻迷你豬,進入本實驗,體重在11 至26 公斤。 七隻肉豬於實驗引發心肌梗塞時有六隻死掉(85.7%),迷你豬則29 隻中有七隻死 掉(24.1%)。右冠狀動脈堵塞者4 隻,3 隻死掉(75%),左前下行冠狀動脈及左 迴旋冠狀動脈堵塞各有16 隻及13 隻,其死亡數分別為3 隻(18.8%)及7 隻(53.8%)。 有3 隻豬並未在心包膜腔注射藥物,有5 隻豬接受纖維蛋白膠注射,1 隻豬接 受纖維蛋白膠及Mitomycin C 4mg ,5 隻豬接受MMC 4mg ,8 隻豬接受MMC 6mg 心胞膜腔注射。接受心胞膜腔MMC 注射的豬中有2 隻發現有明顯心包膜黏連。病 理檢查發現所有引發急性心肌梗塞豬其心臟重量均有明顯增加,但兩隻心胞膜粘 連豬,其心臟重量之增加較不顯著。 總結之,由於在學習曲線上,我們在引發心肌梗塞時死亡率相當高,我們發現LAD 堵塞之死亡率最低。此外引發心包膜粘連之成功率偏低,顯示應尋求更有效之方 法,以引發心包膜粘連。 Acute myocardial infarction (AMI) would proceed to left ventricular remodeling, involving both the infarcted and the noninfarcted segments of left ventricle (LV). During the acute phase of AMI, the noncontractile wall is most vulnerable to early infarct expansion, prior to scar formation. Ventricular dilatation and subsequent remodeling is more prone to occur in patients with large transmural infarctions. Left ventricular remodeling results in a high risk of clinical complications such as aneurysm formation, acute cardiac rupture, recurrent myocardial ischemic events, arrhythmias, and congestive heart failure, with consequent premature mortality in the patients with myocardial infarction. We proposal a hypothesis that soon after AMI, ventricular containment by induction of pericardial adhesion might prevent the process of ventricular remodeling through limiting the expansion and extension of infarct area. To test our hypothesis we performed this study. A total of 36 pigs, 7 farm hogs and 29 mini pigs, were put into this experiment. The weight of the pigs was between 11 and 26 kgs. Among the 7 farm hogs, 6 (85.7%) died during the initial experiment when induction of AMI was attempted. For the mini pigs, 7 (24.1%) from 29 pigs died during the procedure. RCA was the coronary artery occluded in 4 pigs, 3 (75%) of them died during the procedure. LAD and LCX were the vessels intervened in 16 and 13 pigs, respectively, with mortality during the operation in 3 (18.8%) and 7 (53.8%) pigs, respectively. On 3 pigs, chemical injection into pericardial sac was not performed. Fibrin glue injection into pericardial sac was performed on 5 pigs. One pig received injection with both fibrin glue and mitomycin C 4 mg. There were 5 pigs injected with 4 mg of mitomycin C and 8 pigs injected with 6 mg of that drug. There were 2 pigs with marked pericardial adhesion. Other pigs showed no pericardial adhesion. Pathological examination showed marked increase in heart weight in all experimental pigs in which AMI was induced. It seemed that the increase in heart weight was not so remarkable in the 2 pigs which showed pericardial adhesion. It is concluded that in our experiment, due to the learning curve, we have high mortality rate in the process of AMI induction. LAD occlusion would result in lowest mortality rate as comparing to RCA or LCX occlusion. Low success rate in the induction of pericardial adhesion indicates the need for refining the method of induction of pericardial adhesion. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/23660 | 其他識別: | 922314B002312 | Rights: | 國立臺灣大學醫學院內科 |
顯示於: | 醫學系 |
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922314B002312.pdf | 49.39 kB | Adobe PDF | 檢視/開啟 |
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