无创肢体缺血预处理联合后处理对心肌缺血／再灌注损伤的影响  

The impact of noninvasive limb ischemic preconditioning combined with postconditionin8 on ischemia/reperfusion injury

作　　者：张春曦[1] 黄达德[1] 罗兆榴[1] 

机构地区：[1]广州市第一人民医院心胸外科,510180

出　　处：《国际医药卫生导报》2011年第11期1286-1290,共5页International Medicine and Health Guidance News

基　　金：广东省社会发展领域科技计划项目（2010-1096-58）

摘　　要：目的探讨无创肢体缺血预处理（NILIPC）和后处理（NILIPostC）联合应用对体外循环心脏手术中心肌缺血，再灌注损伤的保护作用。方法60例风湿性心脏病拟行机械瓣膜置换者随机分为实验1、2、3组和对照组。实验1组在主动脉阻断前10min右下肢实施NILIPC；实验2组在主动脉开放前10min右下肢实施NILIPostC；实验3组在主动脉阻断前10min右下肢实施NILIPC，主动脉开放前10min左下肢实施NILIPostC；对照组不施加肢体缺血处理。全组患者于手术前、阻断时、开放时、开放后3h、12h、24h、72h检测肌钙蛋白I（cTnI）和心肌酶肌酸酶同工酶（CK—MB）的血清浓度。结果主动脉阻断后，各组CK—MB和cTnI均呈上升趋势，于开放后12h达峰值，其中对照组CK—MB由（21．4±2．95）U／L至（143．9±21．7）u／L，cTnI由0ng／ml至（6．014±1．505）ng／ml，增幅最大；实验3组CK—MB由（19．3±4．19）U／L至（86．7±16．3）U／L，cTnI由0ng／ml至（2．851-I-．0．997）ng／ml，增幅最小。随后下降，实验3组于开放后72h，CK—MB和cTnI达（25．4±10．8）U／L和（0．399±0．107）ng／ml，率先接近术前水平，而实验1、2组和对照组仍明显高于术前（P〈0．05，〈0．01）.开放后3h、12h、24h、72h，实验3组CK—MB（34．9±23．7、86．7±16．3、56．4±17．9、25．4±10．8）U／L，cTn1（1．008±0．415、2．851±0．997、1．130±0．458、0．399±0．107）ng/ml，与对照组CK—MB（57．2±21．3、143．9±21．7、102．7±23．4、61．9±25．1）U／L，cTnI（1．927±0．971、6．014±1．505、3．985±0．892、1．826±0．973）ng／m1分别比较差异均有统计学意义（P〈0．05，〈0．01）；实验3组与实验1组CK—MB（43．2±18．8、112．8±27．1、85．2±22．3、42．7±19．6）U／L，cTnl（1．283±0．437、4．311±1．084、2．201±0．852、0．917±0．226）ng／ml和实验2组CK—MB（49．6±24．5、121�Objective To explore the protective effect of noninvasive limb ischemic posteonditioning （ NILIPC ） and preconditioning （ NILIPostC ） on ischemia/reperfusion injury during open heart surgery, Methods Sixty patients with rheumatic heart disease scheduled for heart mechanical valve replacement were randomly assigned to study group A , B, or C, or control group （ 15 patients for each group ）. NILIPC or NILIPostC was performed 10 minutes before aorta clamping or off-clamping. Group A received NILIPC and group B received NILIPostC on the right thigh; group C received NILIPC on the right and NILIPostC on the left. The control group received routine treatment. ,Serum levels of creatine kinase-MB （ CK-MB ） and cardiac troponin-I （ cTnI ） were measured preoperatively, at the moment of aorta clamping and off-clamping, and at 3h. 12h, 24h, and 72h after off-clamping, Results Levels of CK-MB and cTnI increased gradually after aorta off-clamping, peaked at 12h, then gradually decreased in all the patients. The control group had a largest increase, while group C had a smallest elevation and declined to the baseline at 72h. At 3h, 12h, 24h, and 72h after aorta off-clamping, levels of CK-MB and cTnI were higher in the control group than in group C （ P〈 0.05, P〈 0.01 ）, but the mean levels of CK- MB and cTnI were lower, as compared with those in groups A and B. Conclusions Combination with NILIPC and NILIPostC may synergically protect myocardium from ischemia/reperfusion injury during open heart surgery.

关 键 词：肢体缺血预处理 肢体缺血后处理 无刨 缺血/再灌注损伤 心肌保护 

分 类 号：R65[医药卫生—外科学]