缺血预适应在心脏手术病人中的应用  

Myocardioprotective effects of preconditioning in patients undergoing open heart operation

作　　者：鲁尔雄[1] 陈胜喜[1] 胡铁辉[1] 袁明道[1] 罗万俊[1] 李国虎[1] 许廖梅[1] 

机构地区：[1]湖南医科大学附属湘雅医院心胸外科

出　　处：《中华医学杂志》1998年第5期331-333,共3页National Medical Journal of China

基　　金：湖南省八五科技攻关基金

摘　　要：目的探讨缺血预适应在心内直视手术中对较长时程低温心肌缺血再灌注损伤的保护作用。方法将３０例复杂心内直视手术病人均分为两组，实验组在开心术前实施缺血预适应，分析两组病例心肌腺嘌呤核苷酸含量，心电活动，心肌力学，心肌酶学，及术后恢复过程等方面的变化。结果缺血预适应明显减少了心肌内酶外漏（术后４、１２小时ＣＫＭＢ，Ｐ＜００５），减少了心肌能量消耗，维持较高的ＡＴＰ含量（缺血３０、６０、９０分钟，Ｐ＜００５）；减少了缺血心肌内肌苷的蓄积，维持较低的肌苷／腺苷比值（缺血３０、６０、９０分钟，Ｐ＜００５），保护了内源性抗氧化能力，减轻了自由基损伤，促进了术后心功能恢复。结论缺血预适应对较长时程低温缺血的人类心脏具有明显的保护作用；减少缺血心肌中肌苷蓄积及维持较低的肌苷／腺苷比率。Objective To investigate the myocardial protective effects of ischemic preconditioning (IP) on adult patients who undergoing prolonged open heart operation for complex heart diseases. Methods 30 patients were evenly divided into two groups at random. IP was elicited twice for 2 minutes ischemia from occlusion of vena cava and aorta followed by 3 minutes of reperfusion under cardiopulmonary bypass. Dynamic changes of ATP and purine metabolites in myocardium were measured. Electrocardiogram, leakage of myocardial enzymes, activities of SOD and LPO in serum and myocardial mechanics were investigated. Results IP reduced ATP repletion and maintained a higher ATP content in ischemic myocardium ( P <0.05 vs control group at 30, 60, and 90 minutes of ischemia). Reduced inosine content was found in IP group ( P >0.05). The inosine/adenosine ratio at 30, 60 and 90 minutes of ischemia was 4.2 vs 14.1, 17.6 vs 28.2, 29.2 vs 71.3 for the IP and control groups, respectively, P <0.05). There were also significant differences between the two groups in changes of ST segment shifting, myocardial contractile and early postoperative recovery. Conclusions IP can reduce ischemia reperfusion injury on prolonged ischemic myocardium in humans even when combined with cold cardioplegia. Decreased inosine production and inosine/adenosine ratio in ischemic myocardium may be an important mechanism of IP, by which the production of oxygen free radicals are decreased during early reperfusion

关 键 词：缺血预适应 心肌保护 心内直视术 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]