缺血后处理在心脏瓣膜置换术中的应用  

Cardiopulmonary protection of ischemic postconditioning in patients undergone cardiac valve replacement surgery

作　　者：王冲[1] 陈志明[1] 崔光浩[2] 张步升[2] 

机构地区：[1]复旦大学附属华山医院心胸外科,上海200040 [2]扬州大学第四临床医学院南通瑞慈医院心脏外科

出　　处：《中国心血管杂志》2010年第2期92-95,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的观察缺血后处理对重症心脏瓣膜病行手术治疗患者的心肺保护作用。方法将60例重症心脏瓣膜病患者随机分成常规组和处理组,均行常规手术,处理组于术后给予缺血后处理,即升主动脉开放前间断夹闭主动脉3次。术后以两组患者临床指标、血流动力学及生化指标作为评价指标。结果处理组术后正性肌力药物计分为(14.2±4.1),较常规组(20.3±3.6)减少30%(P<0.05),机械辅助通气时间为(13.45±4.24)h,较常规组(18.43±3.66)h缩短(P<0.05)。处理组平均右心房压(MRAP)、平均肺动脉压(MPAP)、体循环阻力(SVR)分别为(6.9±6.8)mm Hg、(23.8±8.6)mm Hg、(1663.21±210.67)dyn·s·cm^(-5),较常规组[(11.30±4.7)mm Hg、(36.00±6.30)mm Hg、(2608.40±387.27)dyn·s·cm^(-5)]均减低(P<0.05),而心脏指数(CI)为(3.8±0.6)L·min^(-1)·m^(-2),较常规组(3.3±0.6)L·min^(-1)·m^(-2)增高(P<0.05)。处理组在升主动脉开放后2、6、24 h 血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnI)、丙二醛(MDA)均低于常规组(P<0.05或P<0.01),超氧化物歧化酶含量高于常规组(P<0.05或P<0.01)。结论缺血后处理能减轻心脏缺血再灌注损伤,对行手术治疗的重症心脏瓣膜病患者有心肺保护作用。Objective To observe the cardiopulmonary protection effect of ischemic postconditioning in patients undergone valve replacement surgery. Methods A total of 60 patients undergone heart valve replacement were studied and randomly divided into 2 groups ： conventional treatment group （ n = 30 ） and ischemic postconditioning group （ n = 30, ischemic postconditioning was performed by intermittent aortic clamping before reperfusion）. Clinical data, hemodynamic index and biochemical parameters were measured after surgery. Results In ischemic postconditioning group, inotropic drug score was reduced by 30% （ 14. 2 ± 4. 1 ） compared with the conventional group （ 20. 3 ± 3.6 ） （ P 〈 0. 05 ） ; mechanical ventilation time was （13.45±4. 24） h, which was fewer than conventional treatment group [ （18.43 ±3. 66） h, P 〈0. 05 ]. The mean right atrial pressure （MRAP）, mean pulmonary artery pressure （MPAP）, systemic vascular resistance （SVR） were （6.9±6. 8）mm Hg, （23.8 ± 8.6） mm Hg, （ 1663.21 ±210. 67） dyn-s-cm-5 respectively, which were significantly lower than the corresponding parameters in conventional group [ （ 11.30 ± 4. 7 ） mm Hg, （ 36.00 ± 6. 30） mm Hg, （2608.40±387.27） dyn. s cm-5 all P 〈 0.05 ], while cardiac index （CI） [ （ 3.8±0. 6） L min- m-2 ] was higher than in conventional treatment group （ P 〈 0. 05 ）. Serum creatine kinase isoenzyme （ CK-MB ）, cardiac troponin I （cTnI）, malondialdehyde （MDA） in ischemic postconditioning group measured 2, 6 and 24 h after unlocking clamp on aorta were lower than in conventional treatment treaatment group （ P 〈 0. 05 ）, superoxide dismutase （SOD） were higher than in conventional group （ P 〈 0. 05）. Conclusions Ischemic postconditioning has cardiopulmonary protective effects for patients undergone cardiac valve replacement surgery.

关 键 词：心肌再灌注损伤 心肌缺血 心脏瓣膜疾病 

分 类 号：R654.2[医药卫生—外科学]