摘要
目的观察七氟醚预处理对先天性心脏病(CHD)合并肺动脉高压(PAH)患者围术期血清生长分化因子-15(GDF-15)、肿瘤坏死因子-α(TNF-α)、心有肌钙蛋白I(cTnI)表达的影响,探讨其心肌保护作用的机制。方法选取体外循环下行心内直视手术的CHD合并PAH成人患者40例,随机分为七氟醚预处理组(S组)和对照组(C组),每组20例。S组手术开始至主动脉阻断前吸入1MAC的七氟醚20min,随后予以10 min洗脱期,C组只吸入纯氧。分别于麻醉诱导前(T_0)、主动脉开放后2 h(T_1)、12 h(T_2)和24 h(T_3)、术后7 d(T_4)采集桡动脉血,测定GDF-15、TNF-α、cTnI浓度。记录心脏自动复跳率、再灌注心律失常评分、术前及术后肺动脉收缩压(PASP)。结果与术前比较,两组术后7 d PASP均降低(P<0.05);与C组比较,S组心脏自动复跳率升高、再灌注心律失常评分降低(P<0.05);与C组比较,S组T_1~3时GDF-15浓度均升高,TNF-α、cTnI浓度均降低(P<0.05);与T_0时比较,两组T_1~3时GDF-15、TNF-α、cTnI浓度均升高,两组T_4时GDF-15浓度均降低(P<0.05)。结论七氟醚预处理可能通过促进GDF-15的表达,抑制TNF-α的表达减轻CHD合并PAH患者围术期炎性反应,改善心肌缺血再灌注损伤。
Objective To observe the effect of sevoflurane preconditioning on serum GDF-15, TNF-α, cTnI expression during perioperative period in patients in congenital heart diseases （CHD） with pulmonary artery hypertension （PAH）, and to investigate the mechanism of myocardial protection. Methods Forty adult patients of CHD with PAH who received open-heart surgery under extracorporeal circulation were randomly divided into two groups （n = 20） ： sevoflurane preconditioning group （Group S） and the control group （Group C ）. In the group S, 1MAC sevoflurane was inhaled for 20 min from beginning of operation, and followed with oxygen elution for 10 min, in twice ; only inhaling pure oxygen in the Group C. The artery blood samples were collected for measurements of serum GDF-15, TNF-α, cTnI immediately before anesthesia induction （To） , at 2 h （TI） , 12 h （T2） , 24 h （T3） after aorta declamping and 7 d （T4） after operation. The restoration of spontaneous heart beat, reperfusion arrhythmia scores, preoperative and postoperative pulmonary artery systolic pressure were recorded. Results Com- pared with preoperative pumonary artery systolic pressure （PASP） , it became low in the two groups at 7 days after operation （P 〈 0.05） ; compared with the group C, the rate of restoration of spontaneous heart beat was promoted, and reperfusion arrhythmia scores were decreased in the group S （P 〈 0.05） ; compared with the group C, GDF-15 were increased, TNF-α, cTnI were decreased in the group S at T1-3 （P 〈 0.05） ; Compared with To, GDF-15, TNF-α, cTnI were increased in the two groups at T1-3, GDF-15 in the two groups were decreased at T4 （P 〈 0.05）. Conclusion Sevoflurane preconditioning may reduce inflammatory reaction during perioperative period in patients of CHD with PAH by promoting the expression of GDF-15, inhibiting the expression of TNF-α and then improve myocardial ischemia-reperfusion iniury.
出处
《实用医学杂志》
CAS
北大核心
2017年第18期3096-3099,共4页
The Journal of Practical Medicine
基金
安徽省科技厅公益性技术应用研究联动计划项目(编号:1501ld04031)
