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| 远端缺血预处理对全胸腔镜下心脏手术患者心肌的影响 |
| Effects of remote ischaemic preconditioning on cardiac function in heart operation under thoracoscope |
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| DOI： |
| 中文关键词: 远端缺血预处理 心肌保护 缺血-再灌注损伤 全胸腔镜手术 |
| 英文关键词: Remote ischaemic preconditioning Myocardial protection Ischaemic-repefusion injury Thoracoscopy |
| 基金项目:重庆市卫生局医学科研计划项目(2012-2-188);重庆市渝中区科技研究项目(20120226) |
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| 中文摘要: |
目的：研究远端缺血预处理 (remote ischaemic preconditioning, RIPC)对全胸腔镜下心脏瓣膜置换术患者心肌的影响。
方法：选择行全胸腔镜下心脏手术的患者120例, 男72例, 女48例, 年龄41～69岁, 体重49～68 kg, ASA Ⅱ或 Ⅲ 级。将患者随机分为两组: 远端缺血预处理+全胸腔镜体外循环组(RIPC组)和对照组(C组), 每组60例。监测两组RIPC前(T0)、RIPC后即刻(T1)和RIPC后30 min(T2)的pH;监测两组术前、出室前、术后24 h的左心室射血分数(LVEF)和心脏指数(CI), 并在麻醉诱导前、RIPC后6、24和48 h采集静脉血检测肌钙蛋白(cTnI)含量、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)活性;并记录两组患者术中和术后基本情况。
结果：T1时RIPC组pH明显低于C组(P<0.01)。术后24 h RIPC组CI明显高于C组(P<0.05), 而两组各时点LVEF差异无统计学意义。术后6、24 h RIPC组cTnI含量明显低于C组 (P<0.05或P<0.01)。术后6、24和48 h RIPC组CK-MB活性明显低于C组 (P<0.05), 而两组LDH活性差异无统计学意义。两组术中和术后基本情况差异无统计学意义。
结论：远端缺血预处理可减轻全胸腔镜下心脏手术患者心肌损伤, 对缺血-再灌注心肌有一定保护作用。 |
| 英文摘要: |
Objective: To observe the effects of remote ischaemic preconditioning on myocardium in heart operation under thoracoscope.
Methods: One hundred and twenty patients (72 males, 48 females, aged 41-69 years, weighing 49-68 kg, falling into ASA physical status Ⅱ or Ⅲ) who received heart operation under thoracoscope were randomly divided into 2 groups (n=60 each): remote ischaemic preconditioning group (group RIPC) and control group (group C). Comparing the pH value of arterial blood around the RIPC; observing the variation of LVEF and CI at before the operation, before leaving room and 24 h after operation, and the changes of myocardial enzymes (including cTnI, CK-MB and LDH) at basic level and 6, 24 and 48 h after RIPC; comparing the basic state of the two group during the perioperation.
Results: Compared with group C, the pH value of artery blood was lower in group RIPC after RIPC (P<0.01). CI in RIPC group was higher than that in group C at 24 h after operation (P<0.05); there was no statistic difference in LDH between the two groups. The value of cTnI in RIPC group was lower than that in group C at 6 and 24 h after operation (P<0.05 or P<0.01). The value of CK-MB in group RIPC was lower than that in group C at 6, 24 and 48 h after operation (P<0.05);there was no statistic difference in LDH between the two groups. Basic conditions during and after the surgery in two groups had no statistic difference.
Conclusion: Remote ischaemic preconditioning can protect to myocardium during the heart operation under thoracoscope. |
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