杏丁注射液对兔严重心肌挫伤的治疗作用
作者：牛义民，刘达兴，刘日辉，周继红。
Experimental studies on treatment of severe myocardial contusion with Xingding injection in rabbits。
【Abstract】 AIM: To explore the role of Xingding injection (XDI), an injection made of traditional Chinese medicinal herbs, in the treatment of myocardial contusion in rabbits. METHODS: Thirty rabbits were randomly divided into three groups: control group with falseimpact (control group, n=10), severe myocardial contusion group (MC group, n=10) and XDI treatment group (XDI group, n=10). The models of rabbit with severe myocardial contusion were made by BIMII Horizontal Bioimpact Machine. At 5 min before impact and 5 min, 30 min, 2, 4, 8 and 24 h after impact, blood samples were taken from common carotid artery of rabbits in each group to measure the concentrations of plasma thromboxane A2 (TXA2) and prostacyclin (PGI2) by radioimmunoprecipitation. At the end of the experiment, the heart of one rabbit from each group was harvested to observe the microstructural changes and 2 hearts were randomly taken from each group to observe ultrastructural changes. RESULTS: The concentrations of plasma PGI2 had a distinct fallingoff while the contents of plasma TXA2 were significantly higher in the early period of severe myocardial contusion (at 4 h after myocardial contusion). The morphological injuries of myocardial tissues were severe. With XDI, the reduction of the concentrations of plasma PGI2 and the increase of the contents of plasma TXA2 were significantly relieved. The morphological injuries of myocardial tissues were obviously lessened. CONCLUSION: Xingding injection can improve the reduction of the concentrations of plasma PGI2 and the increase of the contents of plasma TXA2 in the early period of severe myocardial contusion, which may concentrate to its therapeutic effect on severe myocardial contusion.
【Keywords】 heart injuries; contusions; PGI2; TXA2; Xingding injection。
【摘要】 目的： 探讨杏丁注射液对心肌挫伤的治疗作用，为临床救治心肌挫伤提供实验依据. 方法： 利用BIMII型生物撞击机制备兔严重心肌挫伤模型；并用杏丁注射液进行治疗作为对照. 分别于撞击前5 min，撞击后5， 30 min， 2， 4， 8， 24 h采颈总动脉血检测血栓素A2（ TXA2）、前列环素（PGI2）的含量；于伤后24h摘取心脏作光镜检查，随机取2只兔心作电镜检查，观察心肌组织形态学改变. 结果： 血浆PGI2浓度在伤后早期（伤后4 h）明显下降，而血浆TXA2浓度则明显升高. 形态学检查心肌组织损伤较重. 用杏丁注射液治疗后血浆PGI2浓度降低和TXA2浓度升高都较轻，心肌组织损伤也明显减轻. 结论： 杏丁注射液对心肌挫伤有治疗作用，其机制可能与杏丁注射液升高血浆PGI2浓度和降低TXA2浓度有关.
【关键词】 心脏损伤；挫伤； PGI2； TXA2；杏丁注射液。
0引言。
心肌挫伤(myocardial contusion, MC)是指钝性暴力所引起的无原发心脏破裂或心内结构损伤的心脏创伤［1］，可发生于交通事故中，亦可发生于高处坠落、胸部受挤压及运动时［2］. MC后常引起程度不等的心脏并发症，如低心排出量、低血压、传导异常、血心包、心源性休克等［3］，严重威胁伤员的生命. 然而，目前临床对MC的治疗尚缺乏有效的药物. 我们探讨杏丁注射液对MC有无治疗作用，为临床救治MC提供实验依据.
1材料和方法 1.1材料。
健康家兔30只，雌雄兼用，体质量（2.5±0.3） kg，分成3组，每组10只. A组： 正常对照组（control group），除为伪撞击（胸壁向内压缩0 cm)外，余均同B组； B组: MC组（MC group），撞击后立即给予生理盐水4 mL/kg iv，并24 h输液以维持兔循环稳定；C组: 杏丁注射液治疗组（Xingding group），除撞击后立即给予杏丁注射液（贵州益佰制药股份有限公司，每5 mL含银杏总黄酮 4.5~5.5 mg，双密达莫1.8~2.2 mg） 4 mL/kg iv外，余均同B组. 采用BIMII型水平式生物撞击机制备兔MC模型：参照文献［4］设置撞击参数：驱动压力为800 kPa，撞击面积为1.77 cm2，撞击时相为心脏收缩末期、呼气末，胸壁向内压缩3 cm（Control 组胸壁向内压缩0 cm）. 根据心动周期采用计算机控制触发系统撞击兔心前区，撞击中心点在第4, 5肋间胸骨左缘旁0.5 cm.
1.2方法。
1.2.1血浆PGI2, TXA2测定各组分别于撞击前5 min,撞击后5, 30 min, 2, 4, 8, 24 h采颈总动脉血用放射免疫非平衡法检测血栓素A2（ TXA2）、前列环素（PGI2）的含量. 因TXA2, PGI2不稳定，直接测量困难，故本实验分别以其稳定的代谢产物6酮前列腺素1a（6ketoPGF1a）、血栓素B2（TXB2）的含量来表示TXA2, PGI2的生成. 具体操作按试剂盒（北京北方生物技术研究所）说明书进行.
1.2.2心肌形态学观察于伤后24 h摘取心脏，在心脏左前降枝远侧端取材（包含左右心室），每组随机取8只行HE染色，光镜下观察，另2只制备超薄切片，在ECNAI10透射电镜下观察.
统计学分析：实验数据以x±s表示，经SPSS10.0软件采用重复测量设计方差分析，P0.05为有统计学意义.