CAJ | 학술논문

【目的】观察远隔缺血时处理在风湿性心脏病瓣膜置换手术中对患者心脏和肾脏的保护作用。【方法】选取风湿性心脏病行瓣膜置换术的患者80例，将其随机分为对照组（A组）和远隔缺血时处理组（B组），每组40例。B组于体外循环主动脉阻断后对患者右下肢大腿（距离膝关节2～3 cm ），以止血带施以压力600 mmHg ，持续5 min ，松开气囊5 min ，重复以上过程3次。分别于术前（T1），开放主动脉前5 min（T2），开放主动脉后30 min （T3），主动脉开放后4 h（T4），和24 h（T5），抽取静脉血测定肌钙蛋白I （cTnI），B型钠尿肽（BNP），尿素氮（BUN），肌酐（SCr），急性肾损伤因子（kim-1）。【结果】两组病例在年龄，质量，体外循环转流时间，主动脉阻断时间以及术前cTnI ，BNP ，BUN ，SCr ，Kim-1无统计学上差别（ P ＞0．05），具有可比性。与T1比较，两组的cTnI在T3，T4，T5较术前有显著性升高；与A组相比，B组有显著性下降（ P ＜0．05）。两组的BNP在T5较术前有显著性升高；与A组相比，B组有显著性下降（ P ＜0．05）。两组的BUN和Scr在T5较术前有显著性升高；与A组相比，B组有显著性下降（ P＜0．05）。两组的Kim-1在T4，T5较术前有显著性升高；与A组相比，B组有显著性下降（ P ＜0．05）。【结论】远隔缺血时处理对于风湿性心脏病行瓣膜置换手术的患者的心脏和肾脏功能有保护作用。
【목적】관찰원격결혈시처리재풍습성심장병판막치환수술중대환자심장화신장적보호작용。【방법】선취풍습성심장병행판막치환술적환자80례，장기수궤분위대조조（A조）화원격결혈시처리조（B조），매조40례。B조우체외순배주동맥조단후대환자우하지대퇴（거리슬관절2～3 cm ），이지혈대시이압력600 mmHg ，지속5 min ，송개기낭5 min ，중복이상과정3차。분별우술전（T1），개방주동맥전5 min（T2），개방주동맥후30 min （T3），주동맥개방후4 h（T4），화24 h（T5），추취정맥혈측정기개단백I （cTnI），B형납뇨태（BNP），뇨소담（BUN），기항（SCr），급성신손상인자（kim-1）。【결과】량조병례재년령，질량，체외순배전류시간，주동맥조단시간이급술전cTnI ，BNP ，BUN ，SCr ，Kim-1무통계학상차별（ P ＞0．05），구유가비성。여T1비교，량조적cTnI재T3，T4，T5교술전유현저성승고；여A조상비，B조유현저성하강（ P ＜0．05）。량조적BNP재T5교술전유현저성승고；여A조상비，B조유현저성하강（ P ＜0．05）。량조적BUN화Scr재T5교술전유현저성승고；여A조상비，B조유현저성하강（ P＜0．05）。량조적Kim-1재T4，T5교술전유현저성승고；여A조상비，B조유현저성하강（ P ＜0．05）。【결론】원격결혈시처리대우풍습성심장병행판막치환수술적환자적심장화신장공능유보호작용。
To observe the protective effect of remote ischemia preconditioning on myocardium and kidney of patients with rheumatic heart disease during valve replacement .[Methods]A total of 80 patients with rheumatic heart disease undergoing valve replacement were chosen and randomly divided into control group(group A ,n=40) and remote ischemia preconditioning group(group B ,n =40) .In group B ,the right thighs(2~3cm near knee joint) of patients were given 600mmHg pressure by tourniquet for 5min after aortic clamping under cardiopulmonary bypass ,and then the balloon was unclamped for 5min .The cycle was repeat-ed for 3 times .Venous blood samples were drawn to measure troponin I (cTnI) ,B-type natriuretic peptide (BNP),urea nitrogen(BUN),serum creatinine(Scr) and acute renal injury factor(Kim-1) before surgery (T1 ) ,5min before aortic de-clamping(T2 ) ,30min(T3 ) ,4h(T4 ) and 24h(T5 )after aortic de-clamping .[Re-sults]There was no significant difference in age ,weight ,cardiopulmonary bypass time ,aortic clamping time and preoperative cTnI ,BNP ,BUN ,Scr and Kim-1 between two groups( P>0 .05) with comparability .Com-pared with T1 ,the cTnI in two groups at T3 ,T4 and T5 were increased significantly ,while those in group B were significantly lower than those in group B ( P < 0 .05) .Compared before operation ,the BNP in two groups at T5 was increased significantly ,while that in group B was significantly lower than that in group A ( P<0 .05) .Compared with before operation ,BUN and Scr in two groups at T5 were increased significantly ,and those in group B were significantly lower than those in group A ( P<0 .05) .Compared with before operation , Kim-1 in two groups at T4 and T5 was increased significantly ,and that in group B was significantly lower than that in group B( P <0 .05) .[Conclusion]Remote ischemic preconditioning can protect the myocardial and re-nal function in patients with rheumatic heart disease undergoing valve replacement .