CAJ | 학술논문

目的评价肢体缺血预处理对CPB下心脏瓣膜置换术患者肝损伤的影响.方法择期CPB下行心脏瓣膜置换术患者60例,性别不限,体重44 ～ 72 kg,ASA分级Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级,左心室射血分数≥40％,采用随机数字表法,将其分为2组(n=30):对照组(C组)和肢体缺血预处理组(E组).E组于麻醉诱导后将止血带置于患者右下肢,充气到300 mmHg,实施3个周期的缺血5 min-再灌注5 min.分别于麻醉诱导前(T0)、术后2 h(T1)、12 h(T2)、24 h(T3)、72 h(T4)和7 d(T5)时,采集右侧颈内静脉血样,检测血清ALT和AST的活性;于T0-4时采用RT-PCR法测定血清微小RNA122(miR-122)的表达水平.结果与T0时比较,2组T2-4时血清ALT和AST的活性升高,T1-3时miR-122表达上调(P＜0.05);与C组比较,T2-4时E组血清ALT和AST的活性降低,T1-3时miR-122表达下调(P＜0.05).结论肢体缺血预处理可减轻CPB下心脏瓣膜置换术患者的肝损伤.
목적 평개지체결혈예처리대CPB하심장판막치환술환자간손상적영향.방법 택기CPB하행심장판막치환술환자60례,성별불한,체중44 ～ 72 kg,ASA분급Ⅱ혹Ⅲ급,심공능Ⅱ혹Ⅲ급,좌심실사혈분수≥40％,채용수궤수자표법,장기분위2조(n=30):대조조(C조)화지체결혈예처리조(E조).E조우마취유도후장지혈대치우환자우하지,충기도300 mmHg,실시3개주기적결혈5 min-재관주5 min.분별우마취유도전(T0)、술후2 h(T1)、12 h(T2)、24 h(T3)、72 h(T4)화7 d(T5)시,채집우측경내정맥혈양,검측혈청ALT화AST적활성;우T0-4시채용RT-PCR법측정혈청미소RNA122(miR-122)적표체수평.결과 여T0시비교,2조T2-4시혈청ALT화AST적활성승고,T1-3시miR-122표체상조(P＜0.05);여C조비교,T2-4시E조혈청ALT화AST적활성강저,T1-3시miR-122표체하조(P＜0.05).결론 지체결혈예처리가감경CPB하심장판막치환술환자적간손상.
Objective To evaluate the effects of extremity ischemic preconditioning on liver injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ), weighing 44-72 kg, with ejection fraction≥40％, schedule for elective cardiac valve replacement with CPB, were randomly divided into 2 groups (n =30 each) using a random number table: control group (group C) and extremity ischemic preconditioning group (group E).Immediately after anesthesia induction, an auto-inflatable cuff was placed under the right lower extremity, and was inflated to 300 mmHg to induce ischemia (oxygen saturation at the finger tip undetected or foot pulse untouched on the operated side) which was preceded by 3 cycles of 5 min ischemia-5 min reperfusion in group E.Before anesthesia induction (T0) , and at 2, 12, 24, and 72 h, and 7 days after operation (T1-5) , blood samples were taken from the right internal jugular vein for determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities.The expression of serum miR-122 was detected at T0-4 by real-time reverse transcriptase polymerase chain reaction.Results Compared with the value at T0, the serum ALT and AST activities were significantly increased at T2-4, and the expression of miR-122 was up-regulated at T1-3 in the two groups (P＜0.05).Compared with group C, the serum ALT and AST activities were significantly decreased at T2-4, and the expression of miR-122 was down-regulated at T1-3in group E (P＜0.05).Conclusion Extremity ischemic preconditioning can mitigate liver injury after cardiac valve replacement with CPB.