60例无创肢体缺血预处理与后处理对心肌的保护作用  

Cardioprotective effect of co-treatment with noninvasive limb ischemic preconditioning and postconditioning in ischemia/reperfusion injury during open heart surgery

作　　者：张春曦[1] 黄达德[1] 罗兆榴[1] 谢健将[1] 

机构地区：[1]广东省广州市第一人民医院心胸外科,510180

出　　处：《重庆医学》2012年第10期951-953,共3页Chongqing medicine

基　　金：广东省社会发展领域科技计划基金资助项目(2010-1096-58)

摘　　要：目的探讨无创肢体缺血预处理(NILIPC)和无创肢体缺血后处理(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1、2、3组和对照组,每组15例。1组在主动脉阻断前10min右下肢实施NILIPC;2组在主动脉开放前10min右下肢实施NILIPostC;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3、12、24、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。结果主动脉开放后四组患者CK-MB和cTnI血清浓度逐步上升,至12h达峰值,之后逐渐下降,其中对照组上升幅度最大,3组上升幅度最小,并于72h率先降至术前水平;主动脉开放后3、12、24、72h,3组与对照组对应时点的CK-MB和cTnI血清浓度比较差异有统计学意义(P<0.05);与1、2组对应时点的CK-MB和cTnI血清浓度比较差异无统计学意义(P>0.05),但4个时点的平均值明显低于1、2组。结论 NILIPC和NILIPostC联合应用可产生加强的心肌保护作用。Objective To explore the cardioprotective effect of co-treatment with noninvasive limb ischemic preconditioning（NILIPC） and postconditioning（NILIPostC） in ischemia/reperfusion injury during open heart surgery.Methods Sixty patients of rheumatic heart disease who were required heart mechanical valve replacement were randomly divided into experimental 1st group（n=15）,2ed group（n=15）,3rd group（n=15）,and control group（n=15）.NILIPC and NILIPostC were administrated 10 minutes before aorta clamping and off-clamping respectively.Experimental 1st group implemented NILIPC on right thigh,experimental 2ed group implemented NILIPostC also on right thigh,experimental 3rd group was taken NILIPC on right thigh and NILIPostC on left thigh respectively,and the control group was given routine treatment.The contents of creatine kinase-MB（CK-MB） and cardiac troponin-I（cTnI） were measured at pre-operation,aorta clamping immediately,aorta off-clamping immediately,and 3 h,12 h,24 h,and 72 h after aorta off-clamping,from the patient jugular vein blood samples.Results In all patients,the serum concentration of CK-MB and cTnI rose gradually after aorta off-clamping,peaked at 12 h,and then gradually decreased.The control group increased most,while experimental 3rd group increased least and dropped to baseline at 72 h.At 3 h,12 h,24 h,and 72h after aorta off-clamping,the contents of CK-MB and cTnI were higher in the control group（P0.05）,compared with the experimental 3rd group.Moreover,the mean contents of CK-MB and cTnI were higher in experimental 1st group and 2ed group.Conclusion Co-treatment 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 无创 再灌注损伤 心肌保护 

分 类 号：R654.2[医药卫生—外科学]