CAJ | 학술논문

【目的】观察远隔缺血预处理对心脏瓣膜置换患者急性肾损伤的影响。【方法】本院择期行心脏瓣膜置换患者60例,随机分为两组：远隔缺血预处理组(R组)和对照组(C组),每组30例。R组在麻醉诱导后对患者右下肢实施3周期5 min 缺血/5 min 再灌注处理,C 组不进行该处理。分别于术前(T0)、体外循环(CPB)后2 h (T1)、6 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)6个时间点检测患者血浆嗜中性粒细胞明胶酶相关脂质运载蛋白(NAGL)和胱抑素C(Cystatin C,Cys C)、血肌酐(SCr)浓度。记录比较患者术后拔管时间、ICU 停留时间及急性肾损伤发生率。【结果】与T0比较,两组血浆 NAGL、Cys C在T2、T3、T4时升高,SCr 在 T4时升高,且差异有显著性(P <0.05)。与C组相比,R组血浆 NAGL、Cys C 浓度在 T2、T3、T4、T5时较低,SCr 在 T4、T5时较低,术后急性肾损伤发生率降低、拔管时间和 ICU停留时间缩短,且两组相比较差异有显著性(P <0.05)。【结论】远隔缺血预处理可减轻心脏瓣膜置换患者急性肾损伤。
【목적】관찰원격결혈예처리대심장판막치환환자급성신손상적영향。【방법】본원택기행심장판막치환환자60례,수궤분위량조：원격결혈예처리조(R조)화대조조(C조),매조30례。R조재마취유도후대환자우하지실시3주기5 min 결혈/5 min 재관주처리,C 조불진행해처리。분별우술전(T0)、체외순배(CPB)후2 h (T1)、6 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)6개시간점검측환자혈장기중성립세포명효매상관지질운재단백(NAGL)화광억소C(Cystatin C,Cys C)、혈기항(SCr)농도。기록비교환자술후발관시간、ICU 정류시간급급성신손상발생솔。【결과】여T0비교,량조혈장 NAGL、Cys C재T2、T3、T4시승고,SCr 재 T4시승고,차차이유현저성(P <0.05)。여C조상비,R조혈장 NAGL、Cys C 농도재 T2、T3、T4、T5시교저,SCr 재 T4、T5시교저,술후급성신손상발생솔강저、발관시간화 ICU정류시간축단,차량조상비교차이유현저성(P <0.05)。【결론】원격결혈예처리가감경심장판막치환환자급성신손상。
[Obj ective]To observe the effects of remote ischemic preconditioning on acute kidney inj ury in pa-tients undergoing valve replacement surgery with cardiopulmonary bypass(CPB).[Methods]A total of 60 patients scheduled for valve replacement with CPB were randomized into 2 groups of remote ischemic preconditioning (R) and control (C)(n=30 each).They were assigned by a random number generator to receive placebo or 3 cycles of 5-min ischemia and 5-min reperfusion on right lower extremity immediately after anesthesia via a tourniquet. The levels of plasma neutrophil gelatinase-associated lipocalin (NGAL),cystatin C (Cys C)and creatinine (SCr) were detected before surgery and at 2,6,24,48 and 72 h after termination of CPB (T0~T5 ).The extubation time,length of intensive care unit (ICU)stay and incidence of acute kidney inj ury were recorded.[Results]Com-pared with group C,the levels of plasma NGAL and Cys C significantly decreased at T2 ,T3 ,T4 and T5 ,SCr sig-nificantly decreased at T4 ,and T5 .the postoperative incidence of acute kidney inj ury decreased and the extubation time and length of ICU were obviously shortened in group R (P <0.05).Compared with T0,plasma NGAL and Cys C at T2 ,T3 and T4 significantly increased and SCr at T4 obviously increased in two groups(P <0.05).[Con-clusion]Remote ischemic preconditioning can reduce acute kidney inj ury in patients undergoing valve replacement.