中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2015年
2期
158-160
,共3页
杨玲%曹定睿%杨春艳%郑斐
楊玲%曹定睿%楊春豔%鄭斐
양령%조정예%양춘염%정비
缺血预处理%心肺转流术%心脏瓣膜假体植入%心肌损伤
缺血預處理%心肺轉流術%心髒瓣膜假體植入%心肌損傷
결혈예처리%심폐전류술%심장판막가체식입%심기손상
Ischemic preconditioning%Cardiopulmonary bypass%Heart valve prosthesis implantation%Myocardial injury
目的 评价延迟远隔缺血预处理对CPB下心脏瓣膜置换术患者心肌损伤的影响.方法 择期行CPB下心脏瓣膜置换术患者41例,性别不限,年龄55 ~ 70岁,体重50~ 75 kg,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组:对照组(C组,n=20)和延迟远隔缺血预处理组(DRLIP组,n=21).DRLIP组在术前24 h行单侧下肢缺血预处理:采用血压计监测血压,加压充气至200 mmHg,持续5 min,进行缺血,放气行再灌注5 min,重复3次.分别于主动脉阻断前、主动脉开放后6h和术后24 h时采集静脉血样,测定血浆心肌肌钙蛋白Ⅰ(cTnI)浓度;分别于主动脉阻断前和CPB结束时,取右心耳组织,检测心肌caspase-3表达和细胞凋亡情况,计算凋亡指数.记录心脏自动复跳情况.结果 与C组比较,DRLIP组主动脉开放后6h时血浆cTn[浓度降低,CPB结束时心肌组织caspase-3表达下调,凋亡指数降低(P<0.05),心脏自动复跳率差异无统计学意义(P>0.05).结论 延迟远隔缺血预处理可减轻CPB下心脏瓣膜置换术患者心肌损伤,其机制与抑制细胞凋亡有关.
目的 評價延遲遠隔缺血預處理對CPB下心髒瓣膜置換術患者心肌損傷的影響.方法 擇期行CPB下心髒瓣膜置換術患者41例,性彆不限,年齡55 ~ 70歲,體重50~ 75 kg,ASA分級Ⅱ或Ⅲ級,NYHA心功能分級Ⅱ或Ⅲ級,採用隨機數字錶法,將其分為2組:對照組(C組,n=20)和延遲遠隔缺血預處理組(DRLIP組,n=21).DRLIP組在術前24 h行單側下肢缺血預處理:採用血壓計鑑測血壓,加壓充氣至200 mmHg,持續5 min,進行缺血,放氣行再灌註5 min,重複3次.分彆于主動脈阻斷前、主動脈開放後6h和術後24 h時採集靜脈血樣,測定血漿心肌肌鈣蛋白Ⅰ(cTnI)濃度;分彆于主動脈阻斷前和CPB結束時,取右心耳組織,檢測心肌caspase-3錶達和細胞凋亡情況,計算凋亡指數.記錄心髒自動複跳情況.結果 與C組比較,DRLIP組主動脈開放後6h時血漿cTn[濃度降低,CPB結束時心肌組織caspase-3錶達下調,凋亡指數降低(P<0.05),心髒自動複跳率差異無統計學意義(P>0.05).結論 延遲遠隔缺血預處理可減輕CPB下心髒瓣膜置換術患者心肌損傷,其機製與抑製細胞凋亡有關.
목적 평개연지원격결혈예처리대CPB하심장판막치환술환자심기손상적영향.방법 택기행CPB하심장판막치환술환자41례,성별불한,년령55 ~ 70세,체중50~ 75 kg,ASA분급Ⅱ혹Ⅲ급,NYHA심공능분급Ⅱ혹Ⅲ급,채용수궤수자표법,장기분위2조:대조조(C조,n=20)화연지원격결혈예처리조(DRLIP조,n=21).DRLIP조재술전24 h행단측하지결혈예처리:채용혈압계감측혈압,가압충기지200 mmHg,지속5 min,진행결혈,방기행재관주5 min,중복3차.분별우주동맥조단전、주동맥개방후6h화술후24 h시채집정맥혈양,측정혈장심기기개단백Ⅰ(cTnI)농도;분별우주동맥조단전화CPB결속시,취우심이조직,검측심기caspase-3표체화세포조망정황,계산조망지수.기록심장자동복도정황.결과 여C조비교,DRLIP조주동맥개방후6h시혈장cTn[농도강저,CPB결속시심기조직caspase-3표체하조,조망지수강저(P<0.05),심장자동복도솔차이무통계학의의(P>0.05).결론 연지원격결혈예처리가감경CPB하심장판막치환술환자심기손상,기궤제여억제세포조망유관.
Objective To evaluate the effects of delayed remote limb ischemic preconditioning (DRLIP) on myocardial injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods A total of 41 patients of both sexes,aged 55-70 yr,weighing 50-75 kg,scheduled for elective cardiac valve replacement under CPB,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅱ or Ⅲ),were randomly divided into 2 groups using a random number table:control group (group C,n =20) and group DRLIP (n =21).In group DRLIP,the patients underwent three 5-min cycles of unilateral lower limb ischemia,induced by a manual cuff-inflator placed on the left thigh and inflated to 200 mmHg starting from 24 h prior to surgery.Blood samples were taken from the central vein before aortic clamping,at 6 h of reperfusion and at 24 h after surgery for determination of plasma cardiac troponin Ⅰ concentrations.Before aortic clamping and at the end of CPB,myocardial tissues were obtained from the right auricle for determination of the expression of caspase-3 and cell apoptosis.Apoptotic index was calculated.The recovery of spontaneous heart beats was recorded.Results Compared with group C,plasma troponin Ⅰ concentrations were significantly decreased at 6 h of reperfusion,and the expression of caspase-3 was downregulated,apoptotic index was decreased at the end of CPB,and no significant change was found in the incidence of recovery of spontaneous heart beats in group DRLIP.Conclusion DRLIP can protect myocardium against injury in the patients undergoing cardiac valve replacement under CPB,and inhibition of cell apoptosis is involved in the mechanism.