中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
9期
1068-1072
,共5页
王焰斌%杨建安%景桂霞%王小雷%黄志勇%翟宇佳%程毅坚%杨晓涵%李刚%王湘
王燄斌%楊建安%景桂霞%王小雷%黃誌勇%翟宇佳%程毅堅%楊曉涵%李剛%王湘
왕염빈%양건안%경계하%왕소뢰%황지용%적우가%정의견%양효함%리강%왕상
胰蛋白酶抑制剂%心肌再灌注损伤%细胞凋亡%缺血预处理,心肌%心肺转流术%心脏瓣膜假体植入%后处理
胰蛋白酶抑製劑%心肌再灌註損傷%細胞凋亡%缺血預處理,心肌%心肺轉流術%心髒瓣膜假體植入%後處理
이단백매억제제%심기재관주손상%세포조망%결혈예처리,심기%심폐전류술%심장판막가체식입%후처리
Trypsin inhibitors%Myocardial reperfusion injury%Apoptosis%Ischemic preconditioning,myocardial%Cardiopulmonary bypass%Heart valve prosthesis implantation%Postconditioning
目的 评价乌司他丁后处理及其联合预处理对CPB下心脏瓣膜置换术患者心肌细胞凋亡的影响.方法 择期CPB下心脏瓣膜置换术患者80例,性别不限,年龄21～59岁,心功能分级Ⅱ或Ⅲ级.采用随机数字表法,将患者随机分为4组(n=20):生理盐水对照组(C组)、乌司他丁预处理组(U1组)、乌司他丁后处理组(U2组)和乌司他丁预处理联合后处理组(U3组).U1组进行乌司他丁预处理:于气管插管后～升主动脉阻断前10 min经中心静脉输注乌司他丁500～ 1000 U·kg-1·min-1(剂量20000U/kg),U2组进行乌司他丁后处理:于主动脉开放前5～7 min经主动脉根部灌注乌司他丁4000～5000 U·kg-1·min-1(剂量l0000U/kg),U3组进行乌司他丁预处理联合后处理,C组给予等容量生理盐水.分别于升主动脉阻断前10 min、升主动脉阻断后40 min、升主动脉开放后45 min和术毕时采集动脉血样,分离血浆,测定血浆肿瘤坏死因子-α (TNF-α)和可溶性肿瘤坏死因子受体l( sTNF-R1)浓度.于升主动脉开放后45 min时取右心耳心肌组织,测定TNF-α、Bcl-2、Bax、caspase-3表达和细胞凋亡情况,并计算Bcl-2与Bax的比值(Bcl-2/Bax比率)和凋亡指数(AI).结果 与C组比较,U1组、U2组和U3组血浆TNF-α和sTNF-R1的浓度及AI降低,心肌组织TNF-α、Bax、caspase-3表达下调,Bcl-2表达上调,Bcl-2/Bax比率升高(P＜0.05)；与U1组和U2组比较,U3组血浆TNF-α和sTNF-R1的浓度和AI降低,心肌组织TNF-α、Bax和caspase-3表达下调,Bcl-2表达上调,Bcl-2/Bax比率升高(P＜0.05).结论 乌司他丁后处理可抑制CPB下心脏瓣膜置换术患者心肌细胞凋亡,联合预处理时其效应增强,其机制与平衡心肌细胞Bcl-2与Bax表达及下调TNF-α及其受体表达有关.
目的 評價烏司他丁後處理及其聯閤預處理對CPB下心髒瓣膜置換術患者心肌細胞凋亡的影響.方法 擇期CPB下心髒瓣膜置換術患者80例,性彆不限,年齡21～59歲,心功能分級Ⅱ或Ⅲ級.採用隨機數字錶法,將患者隨機分為4組(n=20):生理鹽水對照組(C組)、烏司他丁預處理組(U1組)、烏司他丁後處理組(U2組)和烏司他丁預處理聯閤後處理組(U3組).U1組進行烏司他丁預處理:于氣管插管後～升主動脈阻斷前10 min經中心靜脈輸註烏司他丁500～ 1000 U·kg-1·min-1(劑量20000U/kg),U2組進行烏司他丁後處理:于主動脈開放前5～7 min經主動脈根部灌註烏司他丁4000～5000 U·kg-1·min-1(劑量l0000U/kg),U3組進行烏司他丁預處理聯閤後處理,C組給予等容量生理鹽水.分彆于升主動脈阻斷前10 min、升主動脈阻斷後40 min、升主動脈開放後45 min和術畢時採集動脈血樣,分離血漿,測定血漿腫瘤壞死因子-α (TNF-α)和可溶性腫瘤壞死因子受體l( sTNF-R1)濃度.于升主動脈開放後45 min時取右心耳心肌組織,測定TNF-α、Bcl-2、Bax、caspase-3錶達和細胞凋亡情況,併計算Bcl-2與Bax的比值(Bcl-2/Bax比率)和凋亡指數(AI).結果 與C組比較,U1組、U2組和U3組血漿TNF-α和sTNF-R1的濃度及AI降低,心肌組織TNF-α、Bax、caspase-3錶達下調,Bcl-2錶達上調,Bcl-2/Bax比率升高(P＜0.05)；與U1組和U2組比較,U3組血漿TNF-α和sTNF-R1的濃度和AI降低,心肌組織TNF-α、Bax和caspase-3錶達下調,Bcl-2錶達上調,Bcl-2/Bax比率升高(P＜0.05).結論 烏司他丁後處理可抑製CPB下心髒瓣膜置換術患者心肌細胞凋亡,聯閤預處理時其效應增彊,其機製與平衡心肌細胞Bcl-2與Bax錶達及下調TNF-α及其受體錶達有關.
목적 평개오사타정후처리급기연합예처리대CPB하심장판막치환술환자심기세포조망적영향.방법 택기CPB하심장판막치환술환자80례,성별불한,년령21～59세,심공능분급Ⅱ혹Ⅲ급.채용수궤수자표법,장환자수궤분위4조(n=20):생리염수대조조(C조)、오사타정예처리조(U1조)、오사타정후처리조(U2조)화오사타정예처리연합후처리조(U3조).U1조진행오사타정예처리:우기관삽관후～승주동맥조단전10 min경중심정맥수주오사타정500～ 1000 U·kg-1·min-1(제량20000U/kg),U2조진행오사타정후처리:우주동맥개방전5～7 min경주동맥근부관주오사타정4000～5000 U·kg-1·min-1(제량l0000U/kg),U3조진행오사타정예처리연합후처리,C조급여등용량생리염수.분별우승주동맥조단전10 min、승주동맥조단후40 min、승주동맥개방후45 min화술필시채집동맥혈양,분리혈장,측정혈장종류배사인자-α (TNF-α)화가용성종류배사인자수체l( sTNF-R1)농도.우승주동맥개방후45 min시취우심이심기조직,측정TNF-α、Bcl-2、Bax、caspase-3표체화세포조망정황,병계산Bcl-2여Bax적비치(Bcl-2/Bax비솔)화조망지수(AI).결과 여C조비교,U1조、U2조화U3조혈장TNF-α화sTNF-R1적농도급AI강저,심기조직TNF-α、Bax、caspase-3표체하조,Bcl-2표체상조,Bcl-2/Bax비솔승고(P＜0.05)；여U1조화U2조비교,U3조혈장TNF-α화sTNF-R1적농도화AI강저,심기조직TNF-α、Bax화caspase-3표체하조,Bcl-2표체상조,Bcl-2/Bax비솔승고(P＜0.05).결론 오사타정후처리가억제CPB하심장판막치환술환자심기세포조망,연합예처리시기효응증강,기궤제여평형심기세포Bcl-2여Bax표체급하조TNF-α급기수체표체유관.
Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty NYHA class Ⅱ or Ⅲ patients of both sexes,aged 21-59,scheduled for cardiac valve replacement with CPB,were randomly divided into 4 groups ( n =20 each):normal saline control group ( group C ),ulinastatin preconditioning group ( group U1 ),ulinastatin postconditioning group (group U2 ) and ulinastatin preconditioning plus postconditioning group(group U3 ).In group U1,uinastatin 20 000U/kg was infused via central vein at 500-1000 U·kg-1 ·min-1 from after tracheal intubation until 10 min before ascending aortic cross-clamping.In group U2,ulinastatin 10 000 U/kg was perfused via aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 min before aortic unclamping.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C same volume normal saline was infused instead of ulinastatin.Blood samples were taken from radial artery at 10 min before ascending aortic cross-clamping,40 min after ascending aortic cross-clamping,45 min after aortic unclamping and the end of operation for determination of plasma concentrations of TNF-α and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from right atrial appendage at 45 min after aortic unclamping for determination the expression of TNF-d,Bcl-2,Bax and caspase-3 and apoptosis.The Bcl-2/Bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,Bax,caspase-3 and apoptotic index were lower,the expression of Bcl-2 and Bcl-2/Bax ratio were higher in groups U1,U2 and U3 thah group C and in group U3 than groups U1,U2 ( P ＜ 0.05 ).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of Bax and Bcl-2 and down-regulating the expression of TNF-α and its receptor.
