硒对心内直视手术中的心肌缺血再灌注损伤的保护  

SELENIUM PROTECTION OF MYOCARDIAL ISCHEMIA-REPERFUSION INJURY DURING HEART OPERATION

作　　者：景昊[1] 邢西忠[1] 徐平[2] 尤文俊[2] 

机构地区：[1]临沂市人民医院心外科,山东临沂276003 [2]青岛大学医学院附属医院心外科

出　　处：《山东医学高等专科学校学报》2006年第2期89-91,共3页Journal of Shandong Medical College

摘　　要：目的电镜下观察缺血再灌注损伤后心肌线粒体的损伤程度,研究微量元素硒对体外循环下心内直视手术中缺血再灌注损伤心肌的保护作用。方法选择风湿病史10年以上、多瓣膜病变、进行主动脉瓣和/或二尖瓣置换术的风湿性心脏病患者31例。随机分为补硒组16例,未补硒组15例,入院时进行血硒测定,两组比较无明显差异(P>0.05)。选择20例正常人行血硒测定作为对照;补硒组患者术前补硒2周(亚硒酸钠1mg,3次/d)。术中取开放升主动脉恢复心肌血供后30min时的右心房肌,制作标本,电镜下观察心肌细胞线粒体的损伤程度,观察硒对心肌的保护作用。结果补硒组经补硒后患者血硒达到正常人水平,未补硒组患者血硒较补硒组患者血硒明显低,两组比较有显著性差异(P<0.05)。电镜观察未补硒组患者缺血再灌注后的线粒体损伤程度明显高于补硒组(P<0.05)。结论风湿性心脏病患者进行补硒能提高血硒水平,稳定线粒体膜,降低线粒体的损害程度,减轻心脏手术中心肌缺血再灌注损伤。因此,硒对缺血再灌注损伤的心肌有良好的保护作用。Objective To research the relationship between trance selenium and its protection of myocardial ischemia-reperfusion injury during heart operation by analysizing mitochondrla lesion degree with electron microscope. Methods 31 patients suffering from rheumatismal heart disease （RHD） were studied. All the patients with case history more than 10 years and more than one valves involved were classifed randomly into group A（selenium-group supplemented） and group B（non selenlum-supplemented）. The serum selenium level of the patients was examined compared to that of normal cases in another group. Supplementation of selenium was given to the patients in group A for 2 weeks. The serum selenium lerel was examinated again 2 weeks later. Then 16 patients selected from all the patients（8 from group A, the others from group B）. Right artrium myocardia were collected to make electron microscope samples after ischemia-reperfusion injury for 30 minute during valve replacement operation. The mitochondria lesion degree was analysized by electron microscope. Results As to the RHD patients, serum selenium level was lower evidently than that of the normals（ P （0.05）. But it might reach the normal level after selenium supplement. The myocardial mitochondria lesoin after ischemia-reperfusion injury in group B was more serious than that of group A（ P 〈 0.05）. Conclusion Selenium-supplementation to the RHD patients can promote their serum selenium level and diminish the mitochondria lesion degree. Selenium plays a important role in the protection of myocardial ischemia-reperfusion during heart operation.

关 键 词：风湿性心脏病 瓣膜置换术 血硒 电镜 线粒体 缺血再灌注损伤 心肌保护 

分 类 号：O613.52[理学—无机化学] R654.1[理学—化学]