延迟远隔缺血预处理对CPB下心脏瓣膜置换术患者心肌损伤的影响  

Effects of delayed remote limb ischemic preconditioning on myocardial injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：杨玲[1] 曹定睿[1] 杨春艳[1] 郑斐[1] 

机构地区：[1]山西医科大学第一医院麻醉科,太原市030001

出　　处：《中华麻醉学杂志》2015年第2期158-160,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价延迟远隔缺血预处理对CPB下心脏瓣膜置换术患者心肌损伤的影响.方法 择期行CPB下心脏瓣膜置换术患者41例,性别不限,年龄55 ～ 70岁,体重50～ 75 kg,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组：对照组（C组,n=20）和延迟远隔缺血预处理组（DRLIP组,n=21）.DRLIP组在术前24 h行单侧下肢缺血预处理：采用血压计监测血压,加压充气至200 mmHg,持续5 min,进行缺血,放气行再灌注5 min,重复3次.分别于主动脉阻断前、主动脉开放后6h和术后24 h时采集静脉血样,测定血浆心肌肌钙蛋白Ⅰ（cTnI）浓度;分别于主动脉阻断前和CPB结束时,取右心耳组织,检测心肌caspase-3表达和细胞凋亡情况,计算凋亡指数.记录心脏自动复跳情况.结果 与C组比较,DRLIP组主动脉开放后6h时血浆cTn[浓度降低,CPB结束时心肌组织caspase-3表达下调,凋亡指数降低（P＜0.05）,心脏自动复跳率差异无统计学意义（P＞0.05）.结论 延迟远隔缺血预处理可减轻CPB下心脏瓣膜置换术患者心肌损伤,其机制与抑制细胞凋亡有关.Objective To evaluate the effects of delayed remote limb ischemic preconditioning （DRLIP） on myocardial injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB）.Methods A total of 41 patients of both sexes,aged 55-70 yr,weighing 50-75 kg,scheduled for elective cardiac valve replacement under CPB,of ASA physical status Ⅱ or Ⅲ （NYHA Ⅱ or Ⅲ）,were randomly divided into 2 groups using a random number table：control group （group C,n =20） and group DRLIP （n =21）.In group DRLIP,the patients underwent three 5-min cycles of unilateral lower limb ischemia,induced by a manual cuff-inflator placed on the left thigh and inflated to 200 mmHg starting from 24 h prior to surgery.Blood samples were taken from the central vein before aortic clamping,at 6 h of reperfusion and at 24 h after surgery for determination of plasma cardiac troponin Ⅰ concentrations.Before aortic clamping and at the end of CPB,myocardial tissues were obtained from the right auricle for determination of the expression of caspase-3 and cell apoptosis.Apoptotic index was calculated.The recovery of spontaneous heart beats was recorded.Results Compared with group C,plasma troponin Ⅰ concentrations were significantly decreased at 6 h of reperfusion,and the expression of caspase-3 was downregulated,apoptotic index was decreased at the end of CPB,and no significant change was found in the incidence of recovery of spontaneous heart beats in group DRLIP.Conclusion DRLIP can protect myocardium against injury in the patients undergoing cardiac valve replacement under CPB,and inhibition of cell apoptosis is involved in the mechanism.

关 键 词：缺血预处理 心肺转流术 心脏瓣膜假体植入 心肌损伤 

分 类 号：R654.2[医药卫生—外科学]