脱白细胞温血心脏停搏液对心脏瓣膜置换术患者心肌的保护作用  

Myocardial protective effects of warm oxygenated leukocyte-depleted Mood cardioplegia during cardiac valve replacement

作　　者：法宪恩[1] 王海永[2] 董铁立[3] 张瑞成[2] 侯剑峰[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉市现在430022 [2]郑州大学第二附属医院心脏外科 [3]郑州大学第二附属医院麻醉科

出　　处：《中华麻醉学杂志》2005年第6期418-421,共4页Chinese Journal of Anesthesiology

基　　金：河南省自然科学基金资助(0311040300)

摘　　要：目的研究脱白细胞温血心脏停博液微流量连续灌注对体外循环下瓣膜置换术患者心肌的保护效果。方法拟行心脏瓣膜置换术患者4JD例,随机分为对照组和试验组,每组20例。对照组:采用温血心脏停博液微流量连续顺行灌注;试验组:采用脱白细胞的温血心脏停博液微流量连续顺行灌注。采集术中不同时间点静脉血标本,检测血浆类脂肪酸结合蛋白、丙二醛及右心房心肌内髓过氧化物酶水平。结果试验组主动脉开放30、60min血浆类脂肪酸结合蛋白、丙二醛均较主动脉阻断前升高,但均低于对照组(P<0.05)。试验组心肌内髓过氧化物酶在主动脉开放后与阻断前相比差异无统计学意义(P>0.05),而对照组与阻断前相比增加(P<0.05),两组之间比较,差异有统计学意义。结论脱白细胞温血心脏停博液微流量连续灌注,可有效减轻心肌缺血再灌注损伤。Objective To investigate the protective effects of warm oxygenated leukocyte-depleted blood cardioplegia on myocardium during cardiac valve replacement. Methods Forty patients of both sexes undergoing elective valve replacement under CPB were randomly allocated into two groups （ n = 20 each） ： control group and study group. Warm blood cardioplegia was used in both groups, while in study group the leukocytes in the blood used for cardioplegia were depleted with FT-RL type leukocyte filter. The T0 of the cardioplegic solution was maintained at 32-35 ℃. Blood samples were taken for determination of plasma concentrations of human heart fatty acid-binding protein （HH-FABP） and malonaldehyde （MDA） and myocardial tissue was obtained from right atrium for determination of myeloperoxidase （MPO） activity before aortic cross-clamping （T0）, immediately after （T1）and 30 and 60 min after aortic unclamping （T2 , T3 ）. Results The two groups were comparable with regard to sex,age, body weight, height, cardiac function and CPB and aortic cross-clamping time. The plasma concentrations of HH-FABP and MDA were significantly increased after aortic unclamping （T2,3 ） compared to the baseline （T0 ） in both groups but were significantly lower in study group than in control group （ P 〈 0.05 ）. There was no significant change in MPO activity after aortic unclamping （T2,4） compared to the baseline （T0 ） in study group; the MPO activity was significantly increased after aortic unclamping （T1,2 ） compared to the baseline （T0 ） in control group and was significantly higher than that in study group （P 〈 0.05 ） . Conclusion Warm oxygenated leukocyte-depleted blood cardioplegia can attenuate myocardial ischemia-reperfusion injury.

关 键 词：脱白细胞温血心脏停搏液 心脏瓣膜置换术 心肌 保护作用 

分 类 号：R654.2[医药卫生—外科学]