CAJ | 학술논문

目的：探讨七氟醚预处理对体外循环（CPB）手术患者围术期血心肌特异性miRNA-1（miR-1）表达水平的影响，分析七氟醚浓度和miR-1表达水平变化的相关性，进一步阐明七氟醚预防围术期心肌缺血损伤的机制。方法将2013年10月至2014年6月该院胸心外科拟在CPB下行心脏直视手术的40例患者随机分为A、B两组。A组20例行七氟醚预处理；B组20例行常规CPB麻醉。抽取两组患者术前5 min、术中（术后鱼精蛋白拮抗肝素后5 min）和术后6 h血液标本，采用实时荧光定量聚合酶链反应方法检测不同时间点血miR-1含量。结果两组患者术中、术后6 h血液标本中miR-1含量明显高于术前，且相应时间点A组患者血miR-1含量低于与B组，差异均有统计学意义（P<0.05）；七氟醚预处理浓度与术中及术后6 h血miR-1升高的倍数呈负相关（r=-0.41、-0.81，P<0.05）。结论七氟醚预处理可降低血miR-1含量，减轻CPB期间心肌累积损伤，且在一定浓度范围内七氟醚预处理浓度越高，术中及术后6 h血miR-1含量升高倍数越小。
목적：탐토칠불미예처리대체외순배（CPB）수술환자위술기혈심기특이성miRNA-1（miR-1）표체수평적영향，분석칠불미농도화miR-1표체수평변화적상관성，진일보천명칠불미예방위술기심기결혈손상적궤제。방법장2013년10월지2014년6월해원흉심외과의재CPB하행심장직시수술적40례환자수궤분위A、B량조。A조20례행칠불미예처리；B조20례행상규CPB마취。추취량조환자술전5 min、술중（술후어정단백길항간소후5 min）화술후6 h혈액표본，채용실시형광정량취합매련반응방법검측불동시간점혈miR-1함량。결과량조환자술중、술후6 h혈액표본중miR-1함량명현고우술전，차상응시간점A조환자혈miR-1함량저우여B조，차이균유통계학의의（P<0.05）；칠불미예처리농도여술중급술후6 h혈miR-1승고적배수정부상관（r=-0.41、-0.81，P<0.05）。결론칠불미예처리가강저혈miR-1함량，감경CPB기간심기루적손상，차재일정농도범위내칠불미예처리농도월고，술중급술후6 h혈miR-1함량승고배수월소。
Objective To approach the effect of expression level on specific microRNA-1(miR-1) in pretreatment with sevoflurane for patients accepted the intracardiac surgery under cardiopulmonary bypass (CPB) and analyze the correlation between sevoflurane concentration and miR-1 level to set forth the mechanism of prevention from perioperative myocardial ischemia in-jury with sevoflurane further. Methods A total of 40 patients planned to have intracardiac surgery under CPB from October 2013 to June 2014 were divided into two groups. Group A (20 cases) was treated with sevoflurane in advance and group B with rou-tine CPB anesthesia. The blood samples at the time of preoperative 5 minutes ,during the operation (protamine-against-heparin 5 min after the operation) and postoperative 6 hours were collected by the two groups. It is adopted real-time fluoresence quanti-tative polymerase chain reaction to test serum miR-1 content at various time. Results The serum miR-1 contents during the op-eration and 6 h after CPB operation were significantly higher than those before the operation between the two groups. Compare with Group A at the same time,the serum miR-1 content in Group A was lower than that of group B. The difference had statistical significance(P<0.05);The miR-1 levels in group A had a strong negative correlation with the concentration of sevoflurane (r=-0.41,-0.81,P<0.05). Conclusion Pretreatment with sevoflurane may decrease erum miR-1 content,relieve myocardial ischemia in-jury during the CPB. Under certain scope ,the higher the pretreatment concentration with sevoflurane the smaller the serum miR-1 content multipler during the operation and 6 h after the operation.