中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2012年
4期
461-464
,共4页
刘洪端%刘立明%曹亮%谭昌明%张昊%潘彦宏
劉洪耑%劉立明%曹亮%譚昌明%張昊%潘彥宏
류홍단%류립명%조량%담창명%장호%반언굉
缺血后处理/方法%再灌注损伤/病因学/预防和控制%体外循环/副作用
缺血後處理/方法%再灌註損傷/病因學/預防和控製%體外循環/副作用
결혈후처리/방법%재관주손상/병인학/예방화공제%체외순배/부작용
Ischemic postconditioning/methods%Reperfusion injury/etiology/prevention & control%Extracorporeal circulation/adverse effects
目的 通过在联合瓣膜置换术中实施缺血后处理,观察其对体外循环相关肺缺血再灌注损伤的作用,评价不同实施策略的效果,并分析其可能机制.方法 选取风湿性联合瓣膜病变需行双瓣置换患者24例,并均分为对照组(A组)、处理Ⅰ组(B组)、处理Ⅱ组(C组).A组常规行瓣膜置换术,B组常规行瓣膜置换术并在肺动脉恢复灌注前给予阻断主肺动脉15 s、开放15 s、循环5次,C组常规行瓣膜置换术并在肺动脉恢复灌注前给予阻断肺动脉30 s,开放30 s,循环5次.分别记录术前、停机1、2、3、6、12 h的氧合指数,测定术前、停机1、3、6、12 h动脉血浆丙二醛(MDA)含量.结果 B组的氧合指数在停机1、2、3、6h四个时间点明显优于A组和C组(283.25±56.47 vs384.76±29.17 vs 310.50±65.71,265.75±58.78 vs 381.75±29.67 vs 310.50±48.17,283.75±73.15 vs389.74±39.34vs 317.87±78.41,310.37±52.00vs401.62±42.89 vs 337.25±64.06,P均＜0.05),而C和A组差异无统计学意义(P均＞0.05)；B组血浆MDA含量在停机1、3、6、12 h四个时间点明显低于A组和C组(4.64±0.63 vs 3.88±0.20vs 4.38±0.41,5.75±0.49 vs 4.44±0.34vs 5.28±0.76,4.42±0.31 vs3.77±0.40 vs4.35±0.54,3.74±0.31 vs 3.19±0.17 vs 3.64±0.24,P均＜0.05),而C组和A组差异无统计学意义(P均＞0.05).结论 阻断15 s、开放15 s、循环5次的缺血后处理方式能改善体外循环联合瓣膜置换术后肺氧合功能,其机制可能与减轻脂质过氧化损伤有关；阻断30 s、开放30 s、循环5次的缺血后处理方式可能不具有改善体外循环联合瓣膜置换术后肺氧合功能作用.
目的 通過在聯閤瓣膜置換術中實施缺血後處理,觀察其對體外循環相關肺缺血再灌註損傷的作用,評價不同實施策略的效果,併分析其可能機製.方法 選取風濕性聯閤瓣膜病變需行雙瓣置換患者24例,併均分為對照組(A組)、處理Ⅰ組(B組)、處理Ⅱ組(C組).A組常規行瓣膜置換術,B組常規行瓣膜置換術併在肺動脈恢複灌註前給予阻斷主肺動脈15 s、開放15 s、循環5次,C組常規行瓣膜置換術併在肺動脈恢複灌註前給予阻斷肺動脈30 s,開放30 s,循環5次.分彆記錄術前、停機1、2、3、6、12 h的氧閤指數,測定術前、停機1、3、6、12 h動脈血漿丙二醛(MDA)含量.結果 B組的氧閤指數在停機1、2、3、6h四箇時間點明顯優于A組和C組(283.25±56.47 vs384.76±29.17 vs 310.50±65.71,265.75±58.78 vs 381.75±29.67 vs 310.50±48.17,283.75±73.15 vs389.74±39.34vs 317.87±78.41,310.37±52.00vs401.62±42.89 vs 337.25±64.06,P均＜0.05),而C和A組差異無統計學意義(P均＞0.05)；B組血漿MDA含量在停機1、3、6、12 h四箇時間點明顯低于A組和C組(4.64±0.63 vs 3.88±0.20vs 4.38±0.41,5.75±0.49 vs 4.44±0.34vs 5.28±0.76,4.42±0.31 vs3.77±0.40 vs4.35±0.54,3.74±0.31 vs 3.19±0.17 vs 3.64±0.24,P均＜0.05),而C組和A組差異無統計學意義(P均＞0.05).結論 阻斷15 s、開放15 s、循環5次的缺血後處理方式能改善體外循環聯閤瓣膜置換術後肺氧閤功能,其機製可能與減輕脂質過氧化損傷有關；阻斷30 s、開放30 s、循環5次的缺血後處理方式可能不具有改善體外循環聯閤瓣膜置換術後肺氧閤功能作用.
목적 통과재연합판막치환술중실시결혈후처리,관찰기대체외순배상관폐결혈재관주손상적작용,평개불동실시책략적효과,병분석기가능궤제.방법 선취풍습성연합판막병변수행쌍판치환환자24례,병균분위대조조(A조)、처리Ⅰ조(B조)、처리Ⅱ조(C조).A조상규행판막치환술,B조상규행판막치환술병재폐동맥회복관주전급여조단주폐동맥15 s、개방15 s、순배5차,C조상규행판막치환술병재폐동맥회복관주전급여조단폐동맥30 s,개방30 s,순배5차.분별기록술전、정궤1、2、3、6、12 h적양합지수,측정술전、정궤1、3、6、12 h동맥혈장병이철(MDA)함량.결과 B조적양합지수재정궤1、2、3、6h사개시간점명현우우A조화C조(283.25±56.47 vs384.76±29.17 vs 310.50±65.71,265.75±58.78 vs 381.75±29.67 vs 310.50±48.17,283.75±73.15 vs389.74±39.34vs 317.87±78.41,310.37±52.00vs401.62±42.89 vs 337.25±64.06,P균＜0.05),이C화A조차이무통계학의의(P균＞0.05)；B조혈장MDA함량재정궤1、3、6、12 h사개시간점명현저우A조화C조(4.64±0.63 vs 3.88±0.20vs 4.38±0.41,5.75±0.49 vs 4.44±0.34vs 5.28±0.76,4.42±0.31 vs3.77±0.40 vs4.35±0.54,3.74±0.31 vs 3.19±0.17 vs 3.64±0.24,P균＜0.05),이C조화A조차이무통계학의의(P균＞0.05).결론 조단15 s、개방15 s、순배5차적결혈후처리방식능개선체외순배연합판막치환술후폐양합공능,기궤제가능여감경지질과양화손상유관；조단30 s、개방30 s、순배5차적결혈후처리방식가능불구유개선체외순배연합판막치환술후폐양합공능작용.
Objective To investigate the role of ischemic postconditioning on lung ischemic/reperfusion injury induced by cardiopulmonary bypass (CPB) in combined mitral and aortic valve replacement,and evaluate the effects of different protocol of ischemic postconditioning,and analyze its possible mechanisms.Methods 24 patients diagnosed as rheumatic mitral and aortic valve disease with or without tricuspid valve disease were randomly divided into 3 groups (8 in each):Control group( group A),patients undergoing routine cardiac surgery; Postconditioning group Ⅰ (group B ),patients undergoing routine cardiac surgery and ischemic postconditioning by occlusion of the pulmonary artery of five cycles of 15 s ischemia and 15 s repeffusion before the pulmonary artery totally restoring peffusion; Postconditioning group Ⅱ (group C),patients undergoing routine cardiac surgery and ischemic postconditioning by occlusion of the pulmonary artery of five cycles of 30 s ischemia and 30 s repeffusion before the pulmonary artery totally restoring perfusion.The Oxygenation Index (OI) was measured at pre -operation and 1 h,2 h,3 h,6 h and 12 h after terminating CPB.The plasma contents of MDA were detected by Enzyme-linked Immunosorbent Assay at pre -operation,1 h,3 h,6 h and 12 h after terminating CPB.Results Compared with group A and C,OI in group B significantly increased at 1 h,2 h,3 h,6 h after terminating CPB (283.25 ±56.47 vs 384.76 ±29.17 vs 310.50 ±65.71,265.75 ±58.78 vs 381.75 ±29.67 vs 310.50 ±48.17,283.75 ±73.15 vs389.74±39.34 vs 317.87 ±78.41,310.37 ±52.00 vs 401.62 ±4 2.89 vs 337.25 ± 64.06,all P ＜0.05),and the plasma contents of MDA in group B reduced at 1 h,3 h,6 h,12 h after terminating CPB (4.64±0.63 vs 3.88 ±0.20 vs 4.38 ±0.41,5.75±0.49 vs 4.44 ±0.34 vs 5.28 ±0.76,4.42±0.31vs 3.77 ± 0.40 vs 4.35 ± 0.54,3.74 ± 0.31 vs 3.19 ± 0.17 vs 3.64 ± 0.24,all P ＜ 0.05 ), However,there were no significant differences in OI and MDA between group C and A (all P ＞0.05 ).Conclusions Ischemic postconditioning by occlusion of the pulmonary artery of 5 cycles of 15 s ischemia and 15 s reperfusion attenuates lung oxygenation function injury induced by CPB in double valves replacement,and it is possibly mediated by reducing MDA produced by lipid peroxidation.However,ischemic postconditioning by occlusion of the pulmonary artery of 5 cycles of 30 s ischemia and 30 s repeffusion may not have significant protective effect for lung oxygenation function injury induced by CPB in double valves replacement.
