| Background:Myocardial ischemia-reperfusion injury(MIRI) is a frequently pathophysiological changes in ambi-operation, which often bring about severe harmful prognosis on the patient in ambi-operation. From the introduce of origina ischemic preconditioning(IPC), the researchers have one after another discovered which the pharmacological preconditioning still have provided protection on the myocardial of ischemical reperfusion injury,which have provided one safe way of conservation for with potential heart disease and/or with cardiac disease patients in ambi-operation, which experimental study also widely carried out, and have got satisfactory results. But no matter of ischemic preconditioning or pharmacological preconditioning, the time of practice all must had been carried out before patients with myocardial ischemia, however, the time of patients taked place ischemic can not be accurately predicted for the clinician, therefore the preconditioning have been restricted in clinical application. For the past few years, there are some scholars have introducde the ischemic postconditioning(IPP) and pharmacological postconditioning, and which have carried out the correlative investigation, and then discovery that there are a similar protection of myocardial between IPP and IPC, which the protective mechanisms of both sides may not be same. Propofol is a new generation short-acting intravenous anesthetics of non-barbiturate, which play a sedative and hypnotic effects by activating GABA receptor-chloride ion complexes, having fast and reliable characteristics, and widely being used in clinical anesthesia work. Remifentanil is a new synthetic opioid drugs, and in 1996, which have been approved the clinical application by the U.S Food and Drug Administration, the fast of get up effect and the short of action time are outstanding characteristic of the pharmacokinetics of remifentanil, which esteratic linkage conjunction of chemcial constitution, making them easily be hydrolyzed metabolism by non-idiocarboxylesterase, remifentanil is the first truly super-short effect opioid receptor agonists.The study discover that the solo preconditioning of propofol and remifentanil all ease ischemia-reperfusion injury of myocardial, and having myocardial preservation effect. But the post-processing have preferable clinical maneuverability,can effectly protecting the safety of patients during ambi-operation, and having extremely important clinical application perspective and significance.Objective:To investigate there is enhance the injury myocardial protective effects and correlated mechanism with propofol associate remifentanil postconditioning whether better than solo postconditioning.Methods:The 56 rabbits were randomly divided into 7 groups (n= 8):CON group (blank control group); PRO group (propofol postconditioning group); REM group (remifentanil postconditioning group); PRO-REM group (Propofol-Remifentanil the combined postconditioning group); PRO-5HD group (propofol-5HD postconditioning group); REM-5HD (remifentanil-5HD postconditioning group); PRO-REM-5HD (propofol-remifentanil-5HD postconditioning group) ①CON group of stabled, global ischemia 30 minutes, using non-contain any medicine Krebs-Henseleit buffer divided into 3 circular process 12 minutes, reperfusion 120 minutes.②PRO Group ischemic for 30 minutes, using containing propofol of 0.10mmol/L treatment 2 minutes, using Krebs-Henseleit buffer elution 2 minutes, after 3 consecutive cycles, reperfusion 120 minutes.③REM group use containing 60μg/L remifentanil treatment, remaining same as PRO Group④PRO-REM group, using containing propofol and remifentanil mixture processed Group remaining the same as PRO Group.⑤PRO-5HD group, using the mixed liquor of propofol and 5HD processe,remaining the same as PRO Group.⑥REM-5HD groups, using containing the mixed liquor of remifentanil and 5HD processe, remaining the same as PRO Group.⑦PRO-REM-5HD group, using containing the mixed liquor of propofol, remifentanil and 5HD processe, remaining the same PRO Group.All groups were in stable condition for 30 minutes, global ischemia 30 minutes, treatment 2 minutes, elute 2 minutes, a total of three cycles is 12 minutes, reperfusion 120 minutes. whole range record left intraventricular pressure,±dp/dtmax, coronary perfusion pressure, heart rate; stable phase, after reperfusion, to stay perfusate to detect CK, LDH. After the end of the experiment, to measure the infarct size of myocardial after get heart treatment.Results:1,The values of LVDP,±dp/dtmax of PRO Group and REM group all are higher than CON group and added using 5-HD group (P＜0.05), recovery rate is also higher than CON group and added using 5-HD group, the value of LVDP,±dp/dtmax and the recovery rate of PRO-REM group was higher than the other groups (P＜0.05), the heart rate of each group was no statistically significant difference (P＞0.05), the coronary perfusion pressure of PRO Group, REM group, PRO-REM group, CON group, REM-5HD group and PRO-REM-5HD group was no statistically significant difference (P＞0.05).2,The myocardial infarct size of each group is 65.79±8.76%,20.91±1.55%,20.66±1.94%, 21.60±1.98%,30.52±1.18%,34.49±1.56% and 43.20±2.35%, The myocardial infarct size of PRO Group, REM group and PRO-REM group is no statistically significant difference (P＞0.05), The myocardial infarct size of three groups all less than the control group and the other groups (P＜0.05).3,The enzymatic activity of CK and LDH of after reperfusion of PRO Group, REM group and PRO-REM group is no statistically significant difference (P＞0.05), all is lower than the control group and the other groups (P＜0.05).Conclusion:1,propofol, remifentanil alone post-treatment has protective effect on myocardial ischemia-reperfusion injury. Propofol combined with remifentanil post-treatment has protective effect on myocardial ischemia-reperfusion injury, there are enhance the protective effect on the myocardial of both sides combined post-treatment.2,5-HD can partial inhibit the myocardial protective effect of propofol and remifentanil and both combined postconditioning.3,Propofol and remifentanil may be by the opening the mitochondrial adenosine triphosphate sensitive K~+ channel(mitoKATP) produce myocardial protection.
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