缺血后处理对体外循环下心脏瓣膜置换术患者心肌损伤的影响  

Effect of ischemic postconditioning on myocardial injury in patients undergoing cardiac valve re- placement under cardiopulmonary bypass

作　　者：王焰斌[1] 黄志勇[1] 刘志红[2] 郭建洲[2] 张锐[2] 王毅[3] 杨建安[2] 

机构地区：[1]深圳市孙逸仙心血管医院麻醉科,518020 [2]深圳市孙逸仙心血管医院心外科,518020 [3]深圳市孙逸仙心血管医院检验科,518020

出　　处：《中华麻醉学杂志》2016年第6期662-665,共4页Chinese Journal of Anesthesiology

基　　金：广东省医学科学基金（A2013586）;深圳市科创委知识创新计划-基础研究项目（JCYJ20140321105539）

摘　　要：目的评价缺血后处理对体外循环（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30例，性别不限，年龄21～59岁，心功能分级Ⅱ或Ⅲ级，ASA分级Ⅱ或Ⅲ级，左室射血分数≥40％。采用随机数字表法，将患者分为2组（n=15）：对照组（C组）和缺血后处理组（P组）。P组于升主动脉完全开放前5min时，先松开主动脉钳夹30S，再夹闭30S，连续3个循环，行缺血后处理，然后完全松开主动脉钳夹。分别于麻醉诱导后手术前（T1）、升主动脉开放后1h（T2）、术毕（T3）、升主动脉开放后12h（T4）、升主动脉开放后24h（T5）、升主动脉开放后48h（T6）时，采集桡动脉血样，分离血浆，采用ELISA法测定心肌脂肪酶结合蛋白（H—FABP）、缺血修饰蛋白（IMA）和心肌肌钙蛋白I（cTnI）的浓度。于T2时取右心耳心肌组织，光镜下观察病理学结果。结果与T1时比较，2组T2-6时血浆cTnI浓度升高，T2-5时血浆H—FABP和IMA的浓度升高（P〈0．05）；与C组比较，P组T2-6时血浆cTnI浓度降低，T2-4时血浆H-FABP浓度降低，T2,3时血浆IMA降低（P〈0．05），心肌组织病理学损伤减轻。结论缺血后处理可减轻CPB下心脏瓣膜置换术患者心肌损伤。Objective To evaluate the effect of ischemic postconditioning on myocardial injury in the patients undergoing cardiac valve replacement under cardiopulmonary bypass （ CPB）. Methods Thirty patients of both sexes, aged 21-59 yr, of American Society of Anesthesiologists physical status II or III （ New York Heart Association 11 or m ） , with left ventrieular ejection fraction ≥ 40%, scheduled for elective cardiac valve replacement under CPB, were divided into 2 groups （n= 15 each） using a random number table ： control group （ C group） and ischemic postconditioning group （ P group）. In group P, ischemic postconditioning was induced by 3 cycles of 30 s aortic unclamping followed by 30 s cross-clamping starting from 5 min before complete opening of the ascending aorta. After induction of anesthesia and before operation （T1）, at 1 h after opening of the ascending aorta （T2）, at the end of operation （T3）, and at 12, 24 and 48 h after opening of the ascending aorta （ T4-6 ） , blood samples were taken from the radial artery for determination of plasma concentrations of heart-type fatty acid-binding protein （H-FABP） , ischemia-modifled albumin （IMA） , and cardiac troponin I （cTnI）. Myocardial specimens in the right auricle were obtained at T2, and the pathological changes were examined using an optical microscope. Results The concentrations of plasma cTnI at T2-6 and H-FABP and IMA at T2-5 were significantly higher than those at T1 in the two groups （P〈0.05）. Compared with group C, the concentrations of plasma cTnI at T26, H-FABP at T2-4 , and IMA at T2,3 were significantly decreased （P〈0.05） , and the pathological changes of myocardial tissues were significantly reduced in group P. Conclusion Ischemic postconditioning can reduce myocardial injury in the patients undergoing cardiac valve replacement under CPB.

关 键 词：缺血后处理 心肌再灌注损伤 心肺转流术 

分 类 号：R614[医药卫生—麻醉学]