术前局部缺血后适应处理在体外循环冠状动脉旁路移植术中的心肌保护作用  

Myocardial Protective Function in Pre-operative Adapt to Post-local-ischemia in Pump Coronary Artery Bypass Grafting

作　　者：林富强[1] 何志峰[1] 程德志[1] 张翔[1] 金培峰[1] 蒋成榜[1] 姜晓芬[1] 孙成超[1] 

机构地区：[1]温州医科大学附属第一医院胸外科,浙江省温州市325000

出　　处：《中国全科医学》2014年第20期2381-2383,共3页Chinese General Practice

基　　金：温州市社会发展科学研究项目(Y20100241)

摘　　要：目的探讨术前局部缺血后适应处理在体外循环冠状动脉旁路移植术中的心肌保护作用。方法选取2010年8月—2012年8月温州医科大学附属第一医院胸外科收治的行体外循环冠状动脉旁路移植术的冠心病患者72例,将其按随机数字表法分为观察组(42例)和对照组(30例)。其中观察组在行体外循环冠状动脉旁路移植术前进行缺血后适应处理(即在术前造成患者局部心肌缺血,然后再进行恢复,重复几次之后再进行手术);对照组只进行体外循环冠状动脉旁路移植术。观察并比较两组患者术前及术后1、3、5 d时血清肌钙蛋白I(cTnI)、肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)水平。结果两组患者血清cTnI、cTnT、CK-MB水平在不同时间点比较,差异均有统计学意义(P<0.05)。组间比较显示,观察组患者术后1、3、5 d时血清cTnI、cTnT水平均低于对照组(P<0.05);观察组患者术后1、3 d时血清CK-MB水平与对照组比较,差异无统计学意义(P>0.05)。组内比较显示,两组患者术后1、3、5 d时血清cTnI、cTnT水平均高于术前(P<0.05);对照组患者术后5 d时cTnI、cTnT水平低于术后1、3 d(P<0.05);而对照组术后3 d时cTnI、cTnT水平与术后1 d比较,差异无统计学意义(P>0.05)。两组患者术后1 d时CK-MB水平高于术前和术后3 d(P<0.05)。结论术前局部缺血后适应处理减少了体外循环冠状动脉旁路移植术对患者带来的损害,具有保护心肌组织的作用,值得在临床推广应用。Objective To investigate the myocardial protective function in pre - operative adapt to post - local - ischemia in pump coronary artery bypass grafting （CABG）. Methods Seventy - two coronary heart disease （CHD） patients who had pump CABG in department of thoracic surgery, the First Affiliated Hospital of Wenzhou Medical University from August 2010 to August 2012 were divided randomly into groups study （n = 42）, control （n = 30）. The study group had adapt to post -local -ischemia before undergoing CABG （that cause myocardial ischemia in patients with preoperative topical, and then recover , then repeat several times after surgery）, control group only had CABG. The levels of roponin I （cTnI）, troponin T （cTnT） , creatine kinase MB （ CK - MB） were compared between 2 groups before operation and on days 1, 3, 5 after operation. Results There was significant difference of serum cTnI, cTnT, CK - MB levels between 2 groups in different time （ P 〈 0. 05 ）. In group comparison, serum cTnI, cTnT levels were lower in study group than in control group on days 1, 3, 5 after operation. In intra - group comparison, levels of cTnl, cTnT higher on days 1, 3, 5 after operation than before operation between 2 groups （ P 〈 0.05）, and lower on days 5 than on days 1, 3 in control group （P 〈 0. 05）, but there was no difference between on days 3 and on days 1 （ P 〉 0.05 ）. The level of CK - MB was higher on days 3 after operation than before between 2 groups （ P 〈 0. 05 ）, higher on days 3 than on days 1 （ P 〈 0. 05 ）. Conclusion Pre - operative adapt to post - local - ischemia, reducing the harm of CABG to patients, is of protective effects on myocardial tissues.

关 键 词：局部缺血后适应 体外循环 冠状动脉旁路移植术 肌酸激酶 mB型 肌钙蛋白 

分 类 号：R654.1[医药卫生—外科学]