缺血预处理对心脏瓣膜术中脏器的保护作用  

Protective effect of ischemic preconditioning on the viscera during cardiac valve surgery

作　　者：刘建华[1] 蒋伟[1] 石光 梁巧茹[1] 闫小清[1] LIU Jian-hua;JlANG Wei;SHI Guang;LIANG Qiao-ru;YAN Xiao-qing(Department of Exera Corporeal Circulation of Chest pain Center,Henan Provincial Chest Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省胸科医院胸痛中心体外循环科,郑州450008

出　　处：《天津医科大学学报》2018年第6期513-516,523,共5页Journal of Tianjin Medical University

基　　金：河南省医学科技攻关计划项目(201402032)

摘　　要：目的:探讨缺血预处理对心脏瓣膜术中脏器的保护作用。方法:选取行心脏瓣膜置换术治疗的患者55例,采用随机数字表法将患者随机分为观察组(n=30)和对照组(n=25),其中观察组给予加压远隔缺血预处理(采用14 cm宽的压力阻断带系于左侧下肢,其下缘距膝关节3～4cm使阻断带压力保持在200 mmHg,持续5 min以阻断左下肢血流5 min,然后气囊放气5 min,以使左下肢再灌注5 min;重复以上过程3次,共计30 min);对照组仅给予压力阻断带处理,不予充气,观察两组手术情况以及术前(T0)、再灌注后6 h(T1)、12 h(T2)、24 h(T3)和48 h(T4)时肝功能、肾功能、平均动脉压、心率和心肌钙蛋白I。结果:观察组和对照组手术时间、体外循环时间、主动脉阻断时间、ICU停留时间和住院时间比较差异无统计学意义(P>0.05);观察组T1、T2、T3和T4时丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素明显低于对照组(P<0.05);观察组T4时血肌酐和尿素氮明显低于对照组(P<0.05);观察组T2、T3和T4时心肌钙蛋白I明显低于对照组(P<0.05);观察组和对照组T0、T1、T2、T3和T4时HR和MAP比较差异无统计学意义(P>0.05)。结论:在心脏瓣膜术中应用远隔缺血预处理,对患者肝脏、肾脏以及心肌功能有一定保护作用,具有一定的临床应用价值。Objective： To investigate the protective effect of ischemic preconditioning on the viscera during cardiac valve operation. Methods： A total of 55 patients who treated with valve replacement were selected, the observation group （n =30） was given pressured ischemic preconditioning （used 14 cm wide sphygmom anometer on the left lower limb, the cuff pressure was maintained at 200 mmHg for 5 min, the left lower extremity blood flow was blocked for 5 min, and then the sleeve was released by 5 min to make the left lower extremity reperfusion 5min, and repeat the process 3 times for a total of 30 min.）, and the control group （n=25） was only treated with tourniquet, the operation condition, liver function, renal function, mean arterial pressure, heart rate and cardiac troponin I at preoperative （T0）, 6 h （T1）, 12 h （T2）, 24 h （T3） and 48 h （T4） after reperfusion in two groups were observed. Results： There were no significant difference in the operation time, extracorporeal circulation time, aorta blocking time, ICU stay time and hospitalization time in the observation group and control group （P〉0.05）. The ALT, AST and TBIL of T1, T2, T3 and T4 in the observation group were significantly lower than those of the control group （P〈0.05）. The Scr and BUN of T4 in the observation group were significantly lower than those of the control group （P〈0.05）. The cTnI of T2, T3 and T4 in the observation group was significantly lower than that of the control group （P〈0.05）. There were no significant difference in H R and MAP of T0, T1, T2, T3 and T4 between the observation group and the control group （P〉0.05）. Conclusion： The remote ischemic preconditioning in cardiac valvular surgery has certain protective effect on the liver, kidney and myocardial function of the patients, worth clinical application.

关 键 词：缺血预处理 心脏瓣膜置换术 肝功能 肾功能 心肌 

分 类 号：R654.2[医药卫生—外科学]