缺血预处理在心瓣膜置换术中对心肌保护的作用  

Effects of Ischemic Preconditioning on Myocardial Preservation in Patients Undergoing Cardiac Valve Replacement

作　　者：姚尖平[1] 张希[1] 吴钟凯[1] 梁孟亚[1] 王湘[1] 刘喜利[1] 孙培吾[1] 

机构地区：[1]中山大学附属第一医院心脏外科,广州510080

出　　处：《中国胸心血管外科临床杂志》2006年第5期311-314,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省科技厅科技攻关重点引导计划项目(2004B30601012)~~

摘　　要：目的研究单一周期的缺血预处理(IP)方法在心脏瓣膜手术中对心肌的保护作用。方法2002年8月至2006年4月85例慢性心瓣膜疾病患者在我院行心脏瓣膜手术,将其随机分为两组,IP组(n=47):主动脉阻断前实行单次缺血2min开放3min的预处理方案,阻断主动脉后采用冷晶体心脏停搏液心肌保护方法;对照组(n=38):仅采用冷晶体心脏停搏液心肌保护方法。观察两组术前、术后心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、心电图ST-T改变、室性心律失常及ICU临床指标。结果术后两组血清CK-MB和cTnI均较术前升高;IP组术后24、48和72h的CK-MB测量值,以及术后24和48hcTnI测量值均低于对照组(P<0.05)。IP组术后使用抗心律失常药物的比率和持续时间明显低于对照组(P<0.05),术后使用的正性肌力药物种类和ICU停留时间少于/短于对照组(P<0.05)。结论IP和低温高钾晶体心脏停搏液灌注方法联合使用,可以增强心脏瓣膜手术中对心肌的保护效果,降低术后心肌酶、肌钙蛋白上升水平和术后室性心律失常程度,提高手术效果。Objective To investigate whether single cycle ischemic preconditioning （IP） improves the myocardial preservation in patients undergoing cardiac valve replacement. Methods From August 2002 to April 2006, 85 patients who had chronic heart valve disease and required cardiac valve replacement were randomly divided into two groups. IP group, 47 allocated to receive IP and arrested with 4 C St. Thomas＇ Hospital cardioplegic solution during cardiopulmonary bypass（CPB）, preconditioning was accomplished by using single cycle of 2 minutes occlusion of aorta followed by 3 minutes of reperfusion before cross-clamping. Control group, 38 allocated to receive 4 C St. Thomas＇ Hospital cardioplegic solution alone. Myocardial protective effects were assessed by determinations of creatinine kinase-MB isoenzyme （CK-MB） and cardiac troponin I（cTnI）, ST-T changes, ventricular arrhythmias and other clinical data in ICU. Results Serum CK-MB and cTnI concentrations were increased postoperatively in two groups. At 24, 48 and 72h after operation, values of CK-MB in IP group was significantly lower than that in control group （P〈0.05）, cTnI at 24 and 48h after operation also less in IP group （P〈0.05）. The duration for patients needed for antiarrhythmic drugs in IP group was lower than that in control group （P〈0.05）. Compared with control group, fewer inotropic drugs were used in IP group. As a result, ICU stay time in IP group was shorter than that in control group （P〈0.05）. Conclusion IP enhances the myocardial protective effect when it was used with hypothermic hyper kalemic cardioplegic solution in patients undergoing cardiac valve replacement, IP significantly reduces the postoperative increase of CK-MB, cTnI and plessens the severity of postoperative ventricular arrhythmias.

关 键 词：缺血预处理 心瓣膜手术/外科 室性心律失常 肌钙蛋白I 肌酸激酶同工酶 

分 类 号：R654.2[医药卫生—外科学]