局部缺血预适应对非体外循环冠状动脉旁路移植术的心肌保护作用  

MYOCARDIAL PROTECTION OF REGIONAL ISCHEMIC PRECONDITIONING DURING OFFPUMP CORONARY ARTERY BYPASS GRAFTING

作　　者：邓勇志[1] 孙宗全[1] 肖传实[2] 马捷[2] 张文凯[2] 张红星[2] 高清元[2] 李家成[2] 

机构地区：[1]华中科技大学同济医学院协和医院心血管外科,湖北省武汉市430022 [2]山西医科大学第二医院

出　　处：《中国心血管病研究》2004年第6期415-419,共5页Chinese Journal of Cardiovascular Research

基　　金：山西省青年科技研究基金项目(项目编号:20001035)

摘　　要：目的 测定非体外循环冠状动脉旁路移植术(OPCABG)时心肌酶和肌钙蛋白的变化,研究局部缺血预适应对心肌的保护作用。方法 局部缺血预适应组在首支冠状动脉(冠脉)吻合前采用二次左冠状动脉前降支预适应:首次为2min缺血,3min再灌注;第二次为5min缺血,5min再灌注。观察二组手术前后心肌酶和肌钙蛋白的变化。结果 术后心肌酶CK-MB、肌钙蛋白cTn-I和cTn-T均升高。连续测定变量的方差分析显示CK-MB二组之间差别趋于显著(P=0.05);cTn-T二组之间差异无统计学意义(P=0.09);cTn-I二组间差异有统计学意义(P=0.001)。t检验显示术后1,3,5d局部缺血预适应组cTn-I和cTn-T显著低于对照组;局部缺血预适应组cTn-I于血管吻合完成后6h即显著低于对照组。结论 二次局部缺血预适应可以安全地用于OPCABG,保护心肌,避免心肌不可逆性损伤。Objective To investigate whether regional ischemic pr econditioning (rIP) could reduce myocardial injury by testing myocardial enzyme CK-MB, cardiac troponin T and I release in patients undergoing elective off-pump coronary artery bypass surgery. Methods 19 patients with preceding rIp were compared with 17 patients without preceding rIP. The rIP group underwent two additional myocardial regional ischemia of left anterior descending coronary artery (LAD) at the beginning of revascutarization operation, before the ischemic period used for the first coronary artery bypass graft distal anastomosis: there were a 2 -minute period of ischemic followed by a 3 - minute reperfusion period, then a 5 - minute period of ischemia followed by a 5 - minute reperfusion period. Results CK-MB, cTn-I and cTn - T were raised after operation in all patients. The variance analysis of repeated measures demonstrated that CK - MB had borderline significanceP=0.05; cTn-T had no statistical significance P=0.09; while cTn-I had statistical significance P=0.001 between the two groups. The independent test shown in the first, third and fifth post operative days both cTn-I and cTn-T were statistically lower in IP group, and cTn-I was even lower since the sixth hour after revascularization. Conclusion The two cycles of regional 2 - min riP followed by 3 -min reperfusion, then 5 - min rIP followed 5 - min reperfusion in the LAD proved to be applicable and safe in patients undergoing offpump myocardial revascularization, which can protect patients against irreversible myocyte injury to reduce the immediate myocardial CK-MB, cTn-T and cTn-I release.

关 键 词：冠状动脉旁路移植术 缺血预适应 心肌酶 肌钙蛋白 心肌保护 

分 类 号：R654.2[医药卫生—外科学]