体外循环心脏不停跳二尖瓣置换术围术期肾损伤分子-1的变化  

Changes in perioperative kidney injury molecule-1 in beating-heart mitral valve replacement with cardiopulmonary bypass

作　　者：王永勇[1] 戴磊[1] 阳诺[1] 冼磊[1] 郭建极[1] 陈铭伍[1] 

机构地区：[1]广西医科大学第一附属医院心胸外科,南宁市530021

出　　处：《广西医学》2015年第7期913-914,918,共3页Guangxi Medical Journal

基　　金：广西科学研究与技术开发计划(桂科攻1140003A-25);广西医疗卫生重点科研课题(重2010001)

摘　　要：目的研究体外循环(CPB)心脏不停跳与停跳二尖瓣置换术(MVR)围术期尿肾损伤分子-1(KIM-1)的变化规律,探讨心脏不停跳手术对患者肾功能的影响。方法选择需行MVR患者40例,按随机数字表分为不停跳组和停跳组,每组各20例。检测术前(T1)、CPB后30 min(T2)、2 h(T3)、术后24 h(T4)、72 h(T5)的KIM-1浓度。结果组内不同时间点的KIM-1浓度差异有统计学意义(P<0.05),随着时间延长两组KIM-1浓度上升,但不停跳组术后72 h恢复至正常水平,而停跳组72 h后仍未能恢复至术前水平。不停跳组KIM-1浓度低于停跳组(P<0.05)。结论 CPB心脏不停跳MVR患者围术期尿KIM-1浓度变化较小,心脏不停跳手术或可减少肾功能损害。Objective To investigate the regularity of urinary kidney injury molecule-1（ KIM-1） changes in perioperative patients undergoing arrested-versus beating-heart mitral valve replacement（MVR） with cardiopulmonary bypass（CPB）,and to explore the effect of beating-heart surgery on the patients′renal function.Methods Forty MVR patients were randomly divided into beating-heart group and arrested-heart group,with 20 cases in each group.KIM-1 concentrations were detected preoperatively（T1）,30 minutes after CPB（T2）,2 hours after CPB（ T3 ） ,24 hours after operation（ T4 ） ,and 72 hours after operation（ T5 ） ,respectively.Results The concentrations of KIM-1 at different time points showed the significantly statistical differences in two groups（P〈0.05）.The concentration of KIM-1 increased with the increasing time,which became normal 72 hours after operation in the beating-heart group,but didn′t increase to the preoperative level 72 hours after operation in the arrested-heart group.The concentration of KIM-1 in the beating-heart group significantly lower than that in the arrested-heart group（P〈0.05）.Conclusion A little of changes in the concentration of urinary KIM-1 are observed in perioperative patients undergoing beating-heart MVR with CPB.The beating-heart cardiac surgery might reduce renal dysfunction.

关 键 词：肾损伤分子-1 体外循环 心脏不停跳手术 二尖瓣置换术 KIDNEY injury MOLECULE-1 

分 类 号：R541[医药卫生—心血管疾病]