摘要
目的 探讨定量检测血清心肌肌钙蛋白 I(c Tn I) ,并结合临床指标 ,评价心肌缺血预处理 (IPC)对缺血心肌的保护作用。 方法 将 4 0例择期心瓣膜置换术患者随机分为 IPC组和对照组 ,每组 2 0例。IPC组采用 2个周期的 3分钟缺血 +5分钟再灌注方案。两组分别于体外循环 (CPB)前、CPB后、术后 10小时、2 4小时、72小时和 6天测定血清 c Tn I,比较两组间 c Tn I、术毕心脏自动复跳率、术后室性心律失常发生率、正性肌力药物使用率和死亡率。结果 术后两组 c Tn I均立即升高 ,对照组在术后 10小时达峰值 ,而 IPC组在 CPB后即达峰值 ;CPB前和术后 6天两组 c Tn I比较差别无显著性意义 (P>0 .0 5 ) ,其余各时点对照组 c Tn I值均明显高于 IPC组 (P<0 .0 5 ) ;对照组术后室性心律失常发生率和正性肌力药物使用率均明显高于 IPC组 (P<0 .0 5 )。 结论 IPC能降低缺血心肌血清 c Tn I浓度 ,降低患者术后室性心律失常发生率 ,减少术后正性肌力药物的使用率 。
Objective Using serum concentration of cardiac troponin I (cTnI) and clinical data to evaluate the myocardial protection effects of cardiac ischemic preconditioning (IPC) in mechanical heart valve replacement surgery. Methods Forty patients required mechanical heart valve replacement were randomly divided into IPC group and control group with twenty cases in each group. IPC was accomplished using two cycles of 3-minute occlusion of the vena cava and aorta followed by 5-minute of reperfusion under cardiopulmonary bypass (CPB). cTnI were measured in two groups respectively before CPB, after CPB, postoperative 10h,24h,72h and 6 day. Also a series of clinical data were recorded, such as the rate of heart automatic rebeat after aorta off-clamping, ventricular arrhythmia, usage of vasoactive drugs and mortality of the patients. Results Serum concentration of cTnI of both groups went up immediately after operation. It reached the peak value at 10h postoperatively in control group, but in IPC group its peak value appeared right after CPB. Serum levels of cTnI had no difference between the two groups both before CPB and postoperative 6 day( P >0.05). cTnI of control group was obviously higher than that of IPC group of all other point's values( P <0.05). The rates of ventricular arrhythmia, usage of vasoactive drugs in control group were higher than those of IPC group ( P <0.05). Conclusion The study suggests that IPC, as an endogenous myocardial protective measure, could probably improve myocardial protection by reducing the leakage of cTnI and lowering the rates of ventricular arrhythmia, and reduce the usage of vasoactive drugs in the patients after undergoing open heart surgery.
出处
《中国胸心血管外科临床杂志》
CAS
2003年第2期120-123,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
