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老年人往往伴有多种急、慢性疾病，有时需要急症或择期行手术治疗。整个围手术期是一个应激过程，应激可使某些冠心病患者病情加重，冠脉循环受损的患者往往不能耐受。术中心肌缺血与术后心肌梗塞明显相关，因此冠心病心肌缺血围手术期心内科保健是当代冠心病治疗学的一个重大课题。本实验采用开胸和部分结扎冠状动脉前降支（ＬＡＤ），造成７５％以上的管腔狭窄，复制成小型猪心肌缺血模型。７天后再行胃大部切除术。观察手术对缺血ＬＡＤ及正常左旋支（ＬＣ）一氧化氮（ＮＯ）含量、Ｅ－选择素ｍＲＮＡ表达以及对血白细胞Ｌ－选择素ｍＲＮＡ表达的影响。结果显示ＬＤＡ部分结扎后７天其ＮＯ含量下降至５８．０±１．５ｎｍｏｌ／ｇ（Ｐ＜０．０５），手术后ＮＯ含量进一步下降至４５．９±３．５ｎｍｏｌ／ｇ（Ｐ＜０．０５）；而正常ＮＯ含量由６４．０±２．８ｎｍｏｌ／ｇ增高至７２．５±２．３ｎｍｏｌ／ｇ（Ｐ＜０．０１）。ＬＡＤ手术后Ｅ－选择素ｍＲＮＡ由阴性转为阳性；而正常ＬＣＥ－选择素ｍＲＮＡ无变化。术前６只小型猪白细胞Ｌ－选择素ｍＲＮＡ表达均为阴性，术后３０分钟均为强阳性（Ｐ＜０．０１），此后表达量逐渐降低，至术后３小时，已和术前无显著性差异（Ｐ＞０．０５）。提示?
Older people are often accompanied by a variety of acute and chronic diseases, sometimes requiring emergency or elective surgery. The perioperative period is a stressful process, and stress can exacerbate the disease in some patients with coronary artery disease. Patients with impaired coronary circulation often can not tolerate it. Intraoperative myocardial ischemia and postoperative myocardial infarction was significantly related to coronary heart disease, myocardial ischemia perioperative cardiology is a contemporary coronary heart disease treatment of a major issue. In this study, thoracotomy and partial ligation of the anterior descending coronary artery (LAD), resulting in more than 75% of the stenosis, replication into miniature pig myocardial ischemia model. 7 days after the subtotal gastrectomy. To observe the effects of surgery on the content of LAD, normal nitric oxide (NO), the expression of E-selectin mRNA and the expression of L-selectin mRNA in leukocyte. The results showed that the content of NO decreased to 58.0 ± 1.5nmol / g (P <0.05) 7 days after partial ligation of LDA, and the content of NO decreased to 45.9 ± 3.5nmol / g (P <0 .05). However, the NO level increased from 64.0 ± 2.8nmol / g to 72.5 ± 2.3nmol / g (P <0.01). E-selectin mRNA changed from negative to positive after LAD surgery; while normal LCE-selectin mRNA had no change. The expression of L-selectin mRNA in 6 miniature pigs was negative before operation and was strongly positive at 30 minutes after operation (P <0.01). The expression of L-selectin mRNA gradually decreased after 3 hours of operation, Significant difference (P> 0.05). prompt?