心脏不停跳心内直视手术对线粒体耦联因子6表达的影响  

Effect and mechanism of on-pump beating-heart technique on the mitochondrial coupling factor 6

作　　者：周涛[1] 谢晓勇[2] 向道康[1] 

机构地区：[1]贵州省人民医院心脏外科,贵州省贵阳市550002 [2]广西医科大学附属医院胸心外科,贵州省贵阳市550002

出　　处：《中国心血管病研究》2014年第12期1119-1122,共4页Chinese Journal of Cardiovascular Research

基　　金：贵州省科技厅联合基金资助项目（项目编号：黔科合SY[2010]3119号）

摘　　要：目的 探讨浅低温心脏不停跳心内直视手术对体外循环瓣膜置换患者线粒体耦联因子6（CF6）表达的影响.方法 选择2010年1月至2011年11月广西医科大学第一附属医院择期行人工机械瓣膜置换手术患者50例,使用随机数字表法分为心脏停跳组（停跳组,在中度低温心脏停跳下完成心脏瓣膜置换手术）和浅低温心脏不停跳组（不停跳组,在浅低温心脏跳动下完成手术）,每组25例,分别于体外循环转机前（T1）,转机30 min（T2）,开放升主动脉时（T3）,停体外循环后6 h（T4）、24 h（T5）、72 h（T6）、120 h（T7）7个时间点取静脉血,使用放射免疫分析法测定CF6、6-酮-前列环素F1a（6-Keto-PGF1a）的表达.结果 在T2～T5时间点,停跳组CF6浓度（pg/ml）依次为574.3±103.7、855.3±175.8、665.1±95.6、398.9±74.5,较T1时浓度244.5±52.6升高（P＜0.05）;不停跳组CF6浓度（pg/ml）依次为317.1±93.3、673.9±115.1、452.6±81.2、296.2±61.4,较T1时浓度238.4±49.3升高（P＜0.05）;停跳组变化更明显（P＜0.05）.两组均于T6恢复至T1水平.停跳组T2 ～T4时6-Keto-PGF1a浓度（pg/ml）依次为330.7±67.9、435.6±75.8、235.7±35.0,较T1浓度64.3±18.4升高（P＜0.05）;不停跳组T2～T4时浓度（pg/ml）依次为467.4±43.5、573.9±33.1、356.2±41.9,较T1浓度68.3±19.3升高（P＜0.05）;不停跳组升高明显（P＜0.05）.两组均于T5恢复至T1水平.结论 心脏不停跳手术对心肌包括内皮细胞损伤较小是体外循环手术CF6表达上调相对较小的重要原因.CF6的变化可以影响机体前列环素的表达.Objective To investigate the effect of on-pump beating-heart technique on mitochondrial coupling factor 6 （CF6） in patients with heart valve replacements under cardiopulmonary bypass （CPB）.Methods The trial was performed at Department of Cardiothoracic Surgery,the First Affiliated Hospital of Guangxi Medical University,from January 2010 to November 2011.Fifty patients undergoing elective artificial mechanical heart valve replacements with CPB were randomly divided into control group and beating group,25 cases in each group.While the conventional approach was used for 25 patients in the control group,the heart was kept empty and beating throughout the operation in beating group.In all patients,venous blood samples withdrawn at before CPB（T1）,30 min after CPB commencement（T2）,weaning from CPB（T3）,4 h（T4）,24 h（T5）,72 h（T6）,and 120 h （T7） after weaning from CPB were assayed for CF6 and 6-Keto-PGF1a.Results In both groups,compared with the baseline values,plasma levels of CF6[Control group：（574.3±103.7）pg/ml,（855.3±175.8）pg/ml,（665.1± 95.6）pg/ml,（398.9±74.5）pg/ml vs （244.5±52.6）pg/ml,Beating group：（317.1±93.3）pg/ml,（673.9±115.1）pg/ml,（452.6 ±81.2）pg/ml,（296.2 ±61.4）pg/ml vs （238.4 ±49.3）pg/ml] and 6-Keto-PGF1a [Control group：（330.7 ± 67.9）pg/ml,（435.6±75.8）pg/ml,（235.7±35.0）pg/ml vs （64.3±18.4）pg/ml; Beating group：（467.4±43.5）pg/ml,（573.9±33.1）pg/ml,（356.2±41.9）pg/ml vs （68.3 ± 19.3）pg/ml] were gradually increased during CPB.Compared to the control group,the increasing degrees of CF6 were significantly lower in beating group （P〈0.05）,while the increased expression of 6-Keto-PGF1a were larger in beating group（P〈0.05）.Conclusion For the mitigated damage to myocardium,beating-heart technique may reduce the expression of CF6 which affect the change of prostacyclin during the valve surgery under CPB.

关 键 词：心肺转流术 不停跳手术 心肌保护 线粒体耦联因子6 

分 类 号：R654.2[医药卫生—外科学]