大血管手术中应用缺血预处理对肝肾功能的影响  

Effect of ischemic preconditioning on liver and kidney function in surgery for large vessels

作　　者：刘建华[1] 蒋伟[1] 石光 梁巧茹[1] 闫小清[1] LIU Jian-hua;JIANG Wei;SHI Guang(Department for Cardiopulmonary Bypass,Chest Pain Center of Henmz Chest Hospital,Zhengzhou,Henan 450008,China)

机构地区：[1]河南省胸科医院胸痛中心体外循环科,河南郑州450008

出　　处：《中华全科医学》2019年第2期190-192,208,共4页Chinese Journal of General Practice

基　　金：河南省医学科技攻关计划项目(201402032)

摘　　要：目的探讨大血管手术中应用缺血预处理对患者肝肾功能的影响。方法选取2015年2月—2017年7月在河南省胸科医院行大血管手术治疗的患者57例,采用随机数字表法将患者分为观察组(30例)和对照组(27例),其中观察组给予加压远隔缺血预处理,对照组仅给予气压止血带旷置处理,观察2组手术情况以及术前(T0)、停机后1 h(T1)、6 h(T2)、24 h(T3)和48 h(T4)时肝功能和肾功能。结果观察组手术时间、体外循环时间、主动脉阻断时间、ICU停留时间和住院时间比较差异无统计学意义(均P>0.05);观察组和对照组T1、T2、T3和T4时ALT、AST、TBIL和HMGB1均较T0时升高(均P<0.05);观察组T1、T2、T3和T4时ALT、AST、TBIL和HMGB1明显低于对照组(均P<0.05);观察组和对照组T1、T2、T3和T4时Scr、BUN和KIM-1均较T0时升高(均P<0.05);观察组T4时Scr和BUN明显低于对照组(均P<0.05);观察组T2、T3和T4时KIM-1明显低于对照组(均P<0.05)。结论在大血管手术中应用远隔缺血预处理对患者肝脏及肾脏有保护作用,具有一定的临床应用价值。Objective To investigate the effect of ischemic preconditioning(IPC) on the function of liver and kidney in the surgery for large vessels.Methods Total 57 patients undergoing surgery for large vessels in Henan Chest Hospital from February 2015 to July 2017 were selected and randomly divided into observation group(n = 30) and control group(n = 27).The observation group was given pressured remote ischemic preconditioning,while the control group was only treated with tourniquet,operations,the liver function and renal function at before the operation(T0),1 h(T1),6 h(T2),24 h(T3) and 48 h(T4) after CPB were observed and compared between the two groups.Results There were no significant difference in the operation time,extracorporeal circulation time,aorta blocking time,ICU stay time and hospitalization time in the observation group and the control group(all P > 0.05);the levels of ALT,AST,TBIL and HMGB1 of the observation group and the control group at the time of T1,T2,T3 and T4 were higher than those at the T0(all P < 0.05);At the time of T1,T2,T3 and T4,the levels of ALT,AST,TBIL and HMGB1 of the observation group were significantly lower than those of the control group(all P < 0.05);The levels of Scr,BUN and KIM-1 in the observation group and the control group at the time of T1,T2,T3 and T4 were higher than those at the T0(all P < 0.05);The levels of Scr and BUN of T4 in the observation group were significantly lower than those of the control group(all P <0.05);The KIM-1 of T2,T3 and T4 in the observation group was significantly lower than that of the control group(all P < 0.05).Conclusion The application of remote ischemic preconditioning in the surgery for large vessels has a certain protective effect on the injury of the liver and kidney,and has a certain clinical value.

关 键 词：缺血预处理 大血管手术 肝功能 肾功能 

分 类 号：R654.3[医药卫生—外科学] R364.12[医药卫生—临床医学]