CAJ | 학술논문

目的：探讨术前局部缺血后适应处理在体外循环冠状动脉旁路移植术中的心肌保护作用。方法选取2010年8月-2012年8月温州医科大学附属第一医院胸外科收治的行体外循环冠状动脉旁路移植术的冠心病患者72例，将其按随机数字表法分为观察组（42例）和对照组（30例）。其中观察组在行体外循环冠状动脉旁路移植术前进行缺血后适应处理（即在术前造成患者局部心肌缺血，然后再进行恢复，重复几次之后再进行手术）；对照组只进行体外循环冠状动脉旁路移植术。观察并比较两组患者术前及术后1、3、5 d时血清肌钙蛋白 I （ cTnI ）、肌钙蛋白T （ cTnT）和肌酸激酶同工酶（ CK-mB）水平。结果两组患者血清cTnI、cTnT、CK-mB水平在不同时间点比较，差异均有统计学意义（P﹤0.05）。组间比较显示，观察组患者术后1、3、5 d时血清cTnI、cTnT水平均低于对照组（P﹤0.05）；观察组患者术后1、3 d时血清CK-mB水平与对照组比较，差异无统计学意义（ P﹥0.05）。组内比较显示，两组患者术后1、3、5 d时血清cTnI、cTnT水平均高于术前（P﹤0.05）；对照组患者术后5 d时cTnI、cTnT水平低于术后1、3 d（P﹤0.05）；而对照组术后3 d时cTnI、cTnT水平与术后1 d比较，差异无统计学意义（P﹥0.05）。两组患者术后1 d时CK-mB水平高于术前和术后3 d（P﹤0.05）。结论术前局部缺血后适应处理减少了体外循环冠状动脉旁路移植术对患者带来的损害，具有保护心肌组织的作用，值得在临床推广应用。
목적：탐토술전국부결혈후괄응처리재체외순배관상동맥방로이식술중적심기보호작용。방법선취2010년8월-2012년8월온주의과대학부속제일의원흉외과수치적행체외순배관상동맥방로이식술적관심병환자72례，장기안수궤수자표법분위관찰조（42례）화대조조（30례）。기중관찰조재행체외순배관상동맥방로이식술전진행결혈후괄응처리（즉재술전조성환자국부심기결혈，연후재진행회복，중복궤차지후재진행수술）；대조조지진행체외순배관상동맥방로이식술。관찰병비교량조환자술전급술후1、3、5 d시혈청기개단백 I （ cTnI ）、기개단백T （ cTnT）화기산격매동공매（ CK-mB）수평。결과량조환자혈청cTnI、cTnT、CK-mB수평재불동시간점비교，차이균유통계학의의（P﹤0.05）。조간비교현시，관찰조환자술후1、3、5 d시혈청cTnI、cTnT수평균저우대조조（P﹤0.05）；관찰조환자술후1、3 d시혈청CK-mB수평여대조조비교，차이무통계학의의（ P﹥0.05）。조내비교현시，량조환자술후1、3、5 d시혈청cTnI、cTnT수평균고우술전（P﹤0.05）；대조조환자술후5 d시cTnI、cTnT수평저우술후1、3 d（P﹤0.05）；이대조조술후3 d시cTnI、cTnT수평여술후1 d비교，차이무통계학의의（P﹥0.05）。량조환자술후1 d시CK-mB수평고우술전화술후3 d（P﹤0.05）。결론술전국부결혈후괄응처리감소료체외순배관상동맥방로이식술대환자대래적손해，구유보호심기조직적작용，치득재림상추엄응용。
Objective To investigate themyo cardial protective function inpre-operative adapt to post-local-ische-miain pump coronaryartery by pass grafting(CABG).Methods Seventy-two coronary heart disease(CHD)patients who had pump CABG in department of thoracic surgery,the First Affiliated Hospital of Wenzhou medical University from August 2010 to August 2012 were divided randomly into groups study(n=42),control(n=30). The study group had adapt to post-local-ischemia before undergoing CABG(that cause myocardial ischemia in patients with preoperative topical,and then recover , then repeat several times after surgery),control group only had CABG. The levels of roponin I( cTnI),troponin T( cTnT), creatine kinase mB(CK-mB)were compared between 2 groups before operation and on days 1,3,5 after operation. Results TherewassignificantdifferenceofserumcTnI,cTnT,CK-mBlevelsbetween2groupsindifferenttime(P﹤0.05).In group comparison,serum cTnI,cTnT levels were lower in study group than in control group on days 1,3,5 after operation. In intra-group comparison,levels of cTnI,cTnT higher on days 1,3,5 after operation than before operation between 2 groups (P﹤0. 05),and lower on days 5 than on days 1,3 in control group(P﹤0. 05),but there was no difference between on days 3 and on days 1(P﹥0. 05). The level of CK-mB was higher on days 3 after operation than before between 2 groups(P﹤0.05),higherondays3thanondays1(P﹤0.05).Conclusion Pre-operativeadapttopost-local-ischemia,reducing the harm of CABG to patients,is of protective effects on myocardial tissues.