中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
6期
485-489
,共5页
王青廷%冯亚平%胡顺梅%张笃文
王青廷%馮亞平%鬍順梅%張篤文
왕청정%풍아평%호순매%장독문
乙酰半胱氨酸%心肌再灌注损伤%心肺转流术%心脏瓣膜假体植入
乙酰半胱氨痠%心肌再灌註損傷%心肺轉流術%心髒瓣膜假體植入
을선반광안산%심기재관주손상%심폐전류술%심장판막가체식입
Acetylcysteine%Myocardial reperfusion injury%Cardiopulmonary bypass%Heart valve prosthesis implantation
目的 探讨N-乙酰半胱氨酸对体外循环(CPB)下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法 择期CPB下行心脏瓣膜置换术的风湿性心脏病患者22例,性别不限,年龄21-60岁,ASA Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机分为2组(n=11):对照组(C组)和N-乙酰半胱氨酸组(N组).N组预充液中加入N-乙酰半胱氨酸100 mg/kg,停搏液中加入50 mg/kg,C组给予生理盐水替代.于麻醉诱导前10 min和术毕时,记录HR、MAP、中心静脉压(CVP)、肺动脉压(PAP)、肺毛细血管楔压(PCWP)、心输出量(CO)和心脏指数(CI).于切皮前即刻、主动脉开放后0.5、6、12和24 h时,采集桡动脉血样行血气分析,采集中心静脉血样测定血浆白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛(MDA)、心肌肌钙蛋白I(cTnI)的浓度和超氧化物歧化酶(SOD)活性.于CPB前即刻和停机即刻,取心肌组织,计数凋亡细胞,观察心肌细胞超微结构.结果 与c组比较,N组HR、MAP、CVP、PAP、PCWP、pH值、红细胞压积、动脉血氧分压、动脉血二氧化碳分压和剩余碱差异无统计学意义(P>0.05),主动脉开放后TNF-α、IL-6、cTnI和MDA的浓度降低,SOD活性升高,CPB停机即刻心肌凋亡细胞计数降低,术毕CO和CI升高(P<0.05或0.01),心肌病理损伤减轻.结论 N-乙酰半胱氨酸可减轻体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤.
目的 探討N-乙酰半胱氨痠對體外循環(CPB)下心髒瓣膜置換術患者心肌缺血再灌註損傷的影響.方法 擇期CPB下行心髒瓣膜置換術的風濕性心髒病患者22例,性彆不限,年齡21-60歲,ASA Ⅱ或Ⅲ級,心功能Ⅱ或Ⅲ級,隨機分為2組(n=11):對照組(C組)和N-乙酰半胱氨痠組(N組).N組預充液中加入N-乙酰半胱氨痠100 mg/kg,停搏液中加入50 mg/kg,C組給予生理鹽水替代.于痳醉誘導前10 min和術畢時,記錄HR、MAP、中心靜脈壓(CVP)、肺動脈壓(PAP)、肺毛細血管楔壓(PCWP)、心輸齣量(CO)和心髒指數(CI).于切皮前即刻、主動脈開放後0.5、6、12和24 h時,採集橈動脈血樣行血氣分析,採集中心靜脈血樣測定血漿白細胞介素6(IL-6)、腫瘤壞死因子α(TNF-α)、丙二醛(MDA)、心肌肌鈣蛋白I(cTnI)的濃度和超氧化物歧化酶(SOD)活性.于CPB前即刻和停機即刻,取心肌組織,計數凋亡細胞,觀察心肌細胞超微結構.結果 與c組比較,N組HR、MAP、CVP、PAP、PCWP、pH值、紅細胞壓積、動脈血氧分壓、動脈血二氧化碳分壓和剩餘堿差異無統計學意義(P>0.05),主動脈開放後TNF-α、IL-6、cTnI和MDA的濃度降低,SOD活性升高,CPB停機即刻心肌凋亡細胞計數降低,術畢CO和CI升高(P<0.05或0.01),心肌病理損傷減輕.結論 N-乙酰半胱氨痠可減輕體外循環下心髒瓣膜置換術患者心肌缺血再灌註損傷.
목적 탐토N-을선반광안산대체외순배(CPB)하심장판막치환술환자심기결혈재관주손상적영향.방법 택기CPB하행심장판막치환술적풍습성심장병환자22례,성별불한,년령21-60세,ASA Ⅱ혹Ⅲ급,심공능Ⅱ혹Ⅲ급,수궤분위2조(n=11):대조조(C조)화N-을선반광안산조(N조).N조예충액중가입N-을선반광안산100 mg/kg,정박액중가입50 mg/kg,C조급여생리염수체대.우마취유도전10 min화술필시,기록HR、MAP、중심정맥압(CVP)、폐동맥압(PAP)、폐모세혈관설압(PCWP)、심수출량(CO)화심장지수(CI).우절피전즉각、주동맥개방후0.5、6、12화24 h시,채집뇨동맥혈양행혈기분석,채집중심정맥혈양측정혈장백세포개소6(IL-6)、종류배사인자α(TNF-α)、병이철(MDA)、심기기개단백I(cTnI)적농도화초양화물기화매(SOD)활성.우CPB전즉각화정궤즉각,취심기조직,계수조망세포,관찰심기세포초미결구.결과 여c조비교,N조HR、MAP、CVP、PAP、PCWP、pH치、홍세포압적、동맥혈양분압、동맥혈이양화탄분압화잉여감차이무통계학의의(P>0.05),주동맥개방후TNF-α、IL-6、cTnI화MDA적농도강저,SOD활성승고,CPB정궤즉각심기조망세포계수강저,술필CO화CI승고(P<0.05혹0.01),심기병리손상감경.결론 N-을선반광안산가감경체외순배하심장판막치환술환자심기결혈재관주손상.
Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.
