CAJ | 학술논문

背景:动物实验表明将紫外线照射充氧血添加于心停搏液中有一定的心肌保护作用,故推测其对体外循环心内直视手术患者的心肌也有保护作用.目的:课题提出使用紫外线照射充氧血行首次冠状动脉顺行灌注,观察其在老年患者人工生物心脏瓣膜置换体外循环过程中是否对心肌有保护作用.设计、时间及地点:生化水平的随机对照试验,于2006-10/2008-04在贵州省人民医院心脏外科完成.对象:选择贵州省人民医院心脏外科收治需择期行人工生物瓣膜置换的风湿性心脏瓣膜病老年患者46例,按随机数字表法分为2组,每组23例.方法:紫外线照射充氧血组于麻醉后通过锁骨下静脉按10 m/kg放血行紫外线照射充氧(同时经另一静脉途径输入等量生理盐水,术前经过计算,体外循环过程中血红蛋白低于70g/L者,用库血代替自体血行紫外线照射充氧),升主动脉阻断后,将紫外线照射充氧血作为心停搏液组成成分进行首次冠状动脉顺行灌注,之后每30 min常规以4:1冷血/晶体灌注.对照组首次冠状动脉顺行灌注使用不含紫外线照射充氧血的4:1冷血/晶体外,其他处理同治疗组.主要观察指标:于升主动脉阻断前,升主动脉开放后5,10 min从冠状静脉窦取血2 mL,测定超氧化物歧化酶活性及丙二醛浓度.在升主动脉阻断前,停体外循环后4,24,48 h时从中心静脉取血2 mL,测定肌酸激酶同工酶活性及肌钙蛋白I质量浓度.结果:开放升主动脉后,紫外线照射充氧血组冠状静脉窦血清丙二醛浓度低于对照组(P＜0.05),超氧化物歧化酶活性显著高于对照组(P<0.05).紫外线照射充氧血组停体外循环后4-48 的血清肌酸激酶同工酶活性及肌钙蛋白I质量浓度显著低于对照组(P< 0.05).结论:体外循环过程中首次冠状动脉顺行灌注紫外线照射充氧血能提高心肌细胞超氧化物歧化酶活性,减少丙二醛产生,减轻心肌缺血再灌注损伤.降低心肌损伤标志物水平,对老年人工生物心脏瓣膜置换患者具有较好的心肌保护作用. 揹景:動物實驗錶明將紫外線照射充氧血添加于心停搏液中有一定的心肌保護作用,故推測其對體外循環心內直視手術患者的心肌也有保護作用.目的:課題提齣使用紫外線照射充氧血行首次冠狀動脈順行灌註,觀察其在老年患者人工生物心髒瓣膜置換體外循環過程中是否對心肌有保護作用.設計、時間及地點:生化水平的隨機對照試驗,于2006-10/2008-04在貴州省人民醫院心髒外科完成.對象:選擇貴州省人民醫院心髒外科收治需擇期行人工生物瓣膜置換的風濕性心髒瓣膜病老年患者46例,按隨機數字錶法分為2組,每組23例.方法:紫外線照射充氧血組于痳醉後通過鎖骨下靜脈按10 m/kg放血行紫外線照射充氧(同時經另一靜脈途徑輸入等量生理鹽水,術前經過計算,體外循環過程中血紅蛋白低于70g/L者,用庫血代替自體血行紫外線照射充氧),升主動脈阻斷後,將紫外線照射充氧血作為心停搏液組成成分進行首次冠狀動脈順行灌註,之後每30 min常規以4:1冷血/晶體灌註.對照組首次冠狀動脈順行灌註使用不含紫外線照射充氧血的4:1冷血/晶體外,其他處理同治療組.主要觀察指標:于升主動脈阻斷前,升主動脈開放後5,10 min從冠狀靜脈竇取血2 mL,測定超氧化物歧化酶活性及丙二醛濃度.在升主動脈阻斷前,停體外循環後4,24,48 h時從中心靜脈取血2 mL,測定肌痠激酶同工酶活性及肌鈣蛋白I質量濃度.結果:開放升主動脈後,紫外線照射充氧血組冠狀靜脈竇血清丙二醛濃度低于對照組(P＜0.05),超氧化物歧化酶活性顯著高于對照組(P<0.05).紫外線照射充氧血組停體外循環後4-48 的血清肌痠激酶同工酶活性及肌鈣蛋白I質量濃度顯著低于對照組(P< 0.05).結論:體外循環過程中首次冠狀動脈順行灌註紫外線照射充氧血能提高心肌細胞超氧化物歧化酶活性,減少丙二醛產生,減輕心肌缺血再灌註損傷.降低心肌損傷標誌物水平,對老年人工生物心髒瓣膜置換患者具有較好的心肌保護作用.
배경:동물실험표명장자외선조사충양혈첨가우심정박액중유일정적심기보호작용,고추측기대체외순배심내직시수술환자적심기야유보호작용.목적:과제제출사용자외선조사충양혈행수차관상동맥순행관주,관찰기재노년환자인공생물심장판막치환체외순배과정중시부대심기유보호작용.설계、시간급지점:생화수평적수궤대조시험,우2006-10/2008-04재귀주성인민의원심장외과완성.대상:선택귀주성인민의원심장외과수치수택기행인공생물판막치환적풍습성심장판막병노년환자46례,안수궤수자표법분위2조,매조23례.방법:자외선조사충양혈조우마취후통과쇄골하정맥안10 m/kg방혈행자외선조사충양(동시경령일정맥도경수입등량생리염수,술전경과계산,체외순배과정중혈홍단백저우70g/L자,용고혈대체자체혈행자외선조사충양),승주동맥조단후,장자외선조사충양혈작위심정박액조성성분진행수차관상동맥순행관주,지후매30 min상규이4:1랭혈/정체관주.대조조수차관상동맥순행관주사용불함자외선조사충양혈적4:1랭혈/정체외,기타처리동치료조.주요관찰지표:우승주동맥조단전,승주동맥개방후5,10 min종관상정맥두취혈2 mL,측정초양화물기화매활성급병이철농도.재승주동맥조단전,정체외순배후4,24,48 h시종중심정맥취혈2 mL,측정기산격매동공매활성급기개단백I질량농도.결과:개방승주동맥후,자외선조사충양혈조관상정맥두혈청병이철농도저우대조조(P＜0.05),초양화물기화매활성현저고우대조조(P<0.05).자외선조사충양혈조정체외순배후4-48 적혈청기산격매동공매활성급기개단백I질량농도현저저우대조조(P< 0.05).결론:체외순배과정중수차관상동맥순행관주자외선조사충양혈능제고심기세포초양화물기화매활성,감소병이철산생,감경심기결혈재관주손상.강저심기손상표지물수평,대노년인공생물심장판막치환환자구유교호적심기보호작용.
BACKGROUND: Animal experiments demonstrated that adding ultraviolet blood irradiation and oxygenation (UBIO) in cardioplegic solutions has myocardial protection during cardiopulmonary bypass (CPB).OBJECTIVE: To investigate the myocardial protective effect of UBIO as cardiac arresting solution in the process of CPB in old patients undergoing valve replacement.DESIGN, TIME AND SETTING: The randomized controlled trial of biochemistry level was performed at Department of Cardiac Surgery, Guizhou Provincial People's Hospital, from October 2006 to April 2008.PARTICIPANTS: A total of 46 old patients scheduled for heart valve replacement were randomly divided into test group and control group, with 23 patients in each group.METHODS: The test group was infuoed with the UBIO blood as a cardiac arresting solution via the ascending aorta. The UBIO blood accumulated from the subclavian vein (10 mL/kg) was heparinized and dealt with the ultraviolet irradiation (wave length 240-300 nm) and oxygenation. And then it was infused for the first antegrade coronary perfusion when the ascending aorta was cross-clamped, when the UBIO blood was produced, the equivalent quantitative saline was infused from another vein. The 4:1 cold oxygenated blood hyperhalemia cardioplegia was perfused and then maintained for 30 minutes. The control group was the same as the test group except that the cardiac arresting solution presented without the 4:1 cold oxygenated blood.MAIN OUTCOME MEASURES: Blood samples were withdrawn from coronary venous sinus before cross-clamping and at minutes 5 and 10 after aorta declamping, to measure the levels of superoxide dismutase (SOD) and the content of malondialdehyde (MDA). Before the beginning of CPB, and at hours 4, 24, and 48 after the end of CPB, venous blood was drawn to test the serum cardiac troponin I(cTnI) and creatine kinase isozyme (CK-MB).RESULTS: MDA levels of plasma were less in the test group than that of the control group after aorta declamping (P < 0.05),while the SOD activity was obvious greater than the control group (P < 0.05). At hours 4-48 after CPB, CK-MB and cTnl levels were lower in the test group than the control group (P< 0.05).CONCLUSION: Antegrade coronary first perfusion with UBIO during CPB has evident cardiac protective in old patients undergoing valve replacement by elevating SOD activity, decreasing MDA level, relieving myocardial reperfusion injury, as well as decreasing myocardial damage markers levels.