CAJ | 학술논문

目的：研究体外循环（CPB）心脏不停跳与停跳二尖瓣置换术（MVR）围术期尿肾损伤分子－1（KIM－1）的变化规律，探讨心脏不停跳手术对患者肾功能的影响。方法选择需行MVR患者40例，按随机数字表分为不停跳组和停跳组，每组各20例。检测术前（ T1）、CPB后30 min（ T2）、2 h（ T3）、术后24 h（ T4）、72 h（ T5）的KIM－1浓度。结果组内不同时间点的KIM－1浓度差异有统计学意义（P＜0．05），随着时间延长两组 KIM－1浓度上升，但不停跳组术后72 h恢复至正常水平，而停跳组72 h后仍未能恢复至术前水平。不停跳组KIM－1浓度低于停跳组（P＜0．05）。结论 CPB心脏不停跳MVR患者围术期尿KIM－1浓度变化较小，心脏不停跳手术或可减少肾功能损害。
목적：연구체외순배（CPB）심장불정도여정도이첨판치환술（MVR）위술기뇨신손상분자－1（KIM－1）적변화규률，탐토심장불정도수술대환자신공능적영향。방법선택수행MVR환자40례，안수궤수자표분위불정도조화정도조，매조각20례。검측술전（ T1）、CPB후30 min（ T2）、2 h（ T3）、술후24 h（ T4）、72 h（ T5）적KIM－1농도。결과조내불동시간점적KIM－1농도차이유통계학의의（P＜0．05），수착시간연장량조 KIM－1농도상승，단불정도조술후72 h회복지정상수평，이정도조72 h후잉미능회복지술전수평。불정도조KIM－1농도저우정도조（P＜0．05）。결론 CPB심장불정도MVR환자위술기뇨KIM－1농도변화교소，심장불정도수술혹가감소신공능손해。
Objective To investigate the regularity of urinary kidney injury molecule-1( KIM-1) changes in perioperative patients undergoing arrested-versus beating-heart mitral valve replacement(MVR) with cardiopulmonary bypass(CPB),and to explore the effect of beating-heart surgery on the patients′renal function.Methods Forty MVR patients were randomly divided into beating-heart group and arrested-heart group,with 20 cases in each group.KIM-1 concentrations were detected preoperatively(T1),30 minutes after CPB(T2),2 hours after CPB( T3 ) ,24 hours after operation( T4 ) ,and 72 hours after operation( T5 ) ,respectively.Results The concentrations of KIM-1 at different time points showed the significantly statistical differences in two groups(P<0.05).The concentration of KIM-1 increased with the increasing time,which became normal 72 hours after operation in the beating-heart group,but didn′t increase to the preoperative level 72 hours after operation in the arrested-heart group.The concentration of KIM-1 in the beating-heart group significantly lower than that in the arrested-heart group(P<0.05).Conclusion A little of changes in the concentration of urinary KIM-1 are observed in perioperative patients undergoing beating-heart MVR with CPB.The beating-heart cardiac surgery might reduce renal dysfunction.