肢体缺血预处理对婴幼儿心脏手术后心电图变化的观察  

Observation on Electrocardiogram Changes in Infants Undergone Cardiac Operation Pretreated with Limb Remote Ischemic Preconditioning

作　　者：杨哲[1] 陈文娟[1] 胡南[1] 罗元芝[1] 刘勇[1] 周文武[1] 高纪平[1] 

机构地区：[1]湖南省儿童医院,湖南长沙410007

出　　处：《实用预防医学》2009年第2期456-458,共3页Practical Preventive Medicine

基　　金：湖南省卫生厅科技项目(B2006-172)

摘　　要：目的动态观察肢体缺血预处理(RIPC)对婴幼儿心脏手术后心电图(ECG)变化、心律失常情况,从心电图角度评价肢体RIPC的心肌保护效果。方法选取60例体重7kg以下室间隔缺损婴幼儿,随机分为预处理组和对照组(每组30例),预处理组在心脏手术前予以上肢RIPC两次;于RIPC实施时、术后1h及24h描记12导联ECG,术后持续ECG监测记录24h内心律失常发生情况。结果RIPC实施过程中,ECG无ST-T改变,无心律失常;手术后2组患儿心率差异无统计学意义;术后1h,对照组ST-T改变发生率高于处理组(7/30,4/30,P=0.01),术后24h内对照组出现心律失常事件22例,高于处理组16次(22/30,16/30,P=0.04)。结论从ECG及术后心律失常方面,可反映出RIPC对婴幼儿心脏手术相关心肌缺血再灌注损伤有一定的保护效果。Objective To evaluate the cardiac protective effects of limb remote ischemic preconditioning （RIPC） by electrocardiogram （EOG） examination; we observe the EOG changes in infants undergone cardiac operation. Methods Sixty infants weighting less than 7 kilograms were enrolled into this study and randomized into RIPC group or control group （each n = 30）. The RIPC was induced two times （24 hours and 1 hour preoperatively） by three 5 - minute cycles of ischemia and reperfusion on the left upper arm using a blood pressure cuff. The EOG characters were recorded at the time inducing RIPO, and 1 hour and 24 hours postoperatively; and the postoperative arrhythmias events within 24 hours in all infants were also recorded and analyzed. Results No EOG change occurred during the induction of RIPO. One hour postoperatively, the ST segment and T wave abnormalities were found in 7 infants from the control and 4 from the RIPO group （ P = 0.01） ; and 24 hours after operation, the arrhythmias events were observed in 22 infants from the control group and 16 ones from the RIPO group （P = 0.04）. The heart rates of infants from both groups showed no significant difference. Conclusions The cardiac protective efficacy of limb RIPC in infants＇can be detected by ECG which, in turn, can suggest the role of limb RIPC in infants undergoing cardiac defect repair.

关 键 词：缺血预处理 婴幼儿 心电图 心律失常 

分 类 号：R540.41[医药卫生—心血管疾病]