远隔缺血预处理在瓣膜置换手术中的心肌保护作用  

The Protection of Myocardium by Remote Ischemic Preconditioning in Adult Valve Replacement Operation

作　　者：苏杨[1] 吴吉明[1] 陈德祥[1] 刘一[1] 徐伟[1] 陈剑琴[1] 

机构地区：[1]湖南省常德市第一人民医院心胸外科,常德415000

出　　处：《中国现代手术学杂志》2014年第5期327-331,共5页Chinese Journal of Modern Operative Surgery

基　　金：湖南省发改委基金支持项目(2012年)

摘　　要：目的评估远隔缺血预处理在瓣膜置换手术中对心肌的保护作用。方法选取风湿性心脏病行瓣膜置换术的患者80例,将其随机分为远隔缺血预处理组(A组)和对照组(B组),每组各40例,分别于术前(T1)、开放主动脉前5 min(T2)、开放主动脉后30 min(T3)、开放主动脉后4 h(T4)和开放主动脉后24 h(T5)5个时相,动态观察患者心率、平均动脉压、心肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)、B型钠尿肽(B-brain natriuretic peptide,BNP)的变化。结果 1两组患者性别、年龄、体重、射血分数、手术类型、体外循环转流时间、主动脉阻断时间、在ICU停留时间和住院时间的差异无统计学意义(P>0.05);2两组患者的心率和平均动脉压在手术后均明显升高(P<0.001),但各时点两组患者心率、平均动脉压的差异无统计学意义(P>0.05);3两组患者的cTnⅠ在T3、T4、T5较术前有明显升高(P<0.001),远隔缺血预处理组患者在T3、T4和T5时相cTnⅠ较对照组明显下降(P<0.001);4两组患者在T2、T4时相的BNP较术前明显下降,T5时相的BNP较术前明显升高(P<0.001),远隔缺血预处理组患者在T5时BNP较对照组明显下降(P<0.001)。结论在术中阻断时间和体外循环时间无差别的情况下,远隔缺血预处理减轻了心肌的缺血再灌注损伤,在瓣膜置换手术中对心肌起到了保护作用,具有一定的临床应用价值。Objective To estimate the protection effect of myocardium by remote ischemic preconditioning in adult valve replacement operation. Methods Eighty adult patients with valve replacement operation were divided into two groups, one was remote ischemic preconditioning group （A group, n = 40）, another was control group （B group, n = 40）. Heart rate, mean arterial pressure, cardiac troponin I （eTn I ）. B-brain natriuretic peptide（BNP） were measured before surgery（ T1 ）, 5 minutes before aortic de-clamping（ T2 ）, 30 minutes （T3）, four hours （T4） and twenty-four hours （T5） after aortic de-clamping. Results ①There was no significant difference of the gender, age, body weight, ejection fraction, operation type, cardiopulmonary bypass time, aortic clamping time, retention time in ICU and hospitalization time between the two groups （P 〉 0. 05）. ②The heart rate and mean arterial pressure significantly increased after operation （P 〈 0. 001 ）, but there was no significant difference between the two groups （P 〉 0.05）. ③The cTn I significantly increased at T3, T4, T5 after operation in both two groups （P 〈 0. 001 ）. But it decreased more significantly in the remote ischemic preconditioning group than that of the control group （ P 〈 0. 001 ）. ③The BNP significantly decreased atT2, T4 and significantly increased at T5 （P 〈0. 001 ） in both two groups. But it was lower in the remote ische mic preconditioning group at T5 than that of the control group （P 〈 0.001 ）. Conclusion It can reduce the myocardial ischemia-repeffusion injury and protect the myocardium of the remote ischemic preconditioning in valve replacement operation with certain clinical application value.

关 键 词：缺血预处理 心肌 心脏瓣膜假体植入 心肌再灌注损伤 

分 类 号：R654.2[医药卫生—外科学]