不停跳心内直视手术对心肌细胞凋亡的影响  

Influence of Beating Open Heart Operation to Cardiomyocytes Apoptosis

作　　者：熊利华[1] 黄景彬[2] 魏益平[1] 李佳[1] 祝曙光[3] 华平[1] 王铭辉[1] 张华[1] 

机构地区：[1]中山大学附属第二医院心胸外科,广东广州510120 [2]广西医科大学第五附属医院//柳州市人民医院心胸外科,广西柳州545001 [3]香港大学心血管疾病研究所

出　　处：《中山大学学报（医学科学版）》2007年第5期562-564,569,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(6021339)

摘　　要：【目的】评价不停跳体外循环心内直视手术对心肌细胞凋亡的影响和探讨其临床意义。【方法】停跳心内直视手术患者25例(A组),不停跳心内直视手术患者20例(B组),取心肌组织作TUNEL细胞凋亡检测,比较分析术前和术后心肌细胞凋亡率并参照围手术期肌钙蛋白T(cTnT)检测。【结果】两组患者均无低心输出量综合征的发生。心肌细胞凋亡指数A组(0.003±0.002)和B组(0.004±0.003)术前无明显差别(P>0.05);术后心肌细胞凋亡指数A组(0.012±0.008,P<0.001)和B组(0.006±0.004,P<0.001)均高于术前;A、B两组术后心肌细胞凋亡指数差别有明显差别(P<0.05)。围手术期cTnT水平A组在CPB末和术后2 h明显高于B组(P<0.05)。【结论】本实验提示不停跳体外循环心内直视手术引起心肌细胞凋亡和心肌损害小于停跳手术。[ Objective ] To investigate cardiomyocytes apoptosis in beating heart surgery with extra-corporeal circulation and to evaluate its clinical value. [Methods] Cardiomyocytes apoptosis were detected by TUNEL methods, perioperative cTnT level were record and compared between before and after the open heart surgery in the arrested heart surgery group 25 cases （Group A） and beating heart surgery group 20 cases （Group B）. [Results] There were no low-output syndrome in both two groups. Cardiomyocytes apoptosis index has no difference between Group A （0.003±0.002） and Group B （0.004±0.003） preoperatively （P 〉0.05）, the postoperative apoptosis index were significantly higher than those of preoperative in both Group A （0.012±0.008, P〈 0.001） and Group B （0.006± 0.004,P〈 0.001）. Postoperative apoptosis index in Group A was higher statistically significant （P〈 0.05）. Perioperative cTnT detection revealed a higher level in Group A than in Group B only at the point of CPB end and 2 hours after operation. [Conclusion] These results suggested that beating heart surgery has less implication in cardiomyocytes apoptosis than the conventional arrested heart surgery.

关 键 词：不停跳心脏手术 心肌细胞 细胞凋亡 肌钙蛋白T 

分 类 号：R654.2[医药卫生—外科学]