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[1]刘建华,蒋 伟,石 光,等.缺血预处理对心脏瓣膜术中脏器的保护作用[J].天津医科大学学报,2018,24(06):513-516.
　LIU Jian-hua,JIANG Wei,SHI Guang,et al.Protective effect of ischemic preconditioning on the viscera during cardiac valve surgery[J].Journal of Tianjin Medical University,2018,24(06):513-516.
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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
24卷
期数:
2018年06期
页码:
513-516
栏目:
临床医学
出版日期:
2018-11-20

文章信息/Info

Title:
Protective effect of ischemic preconditioning on the viscera during cardiac valve surgery
作者:
刘建华; 蒋 伟; 石 光; 梁巧茹; 闫小清
（河南省胸科医院胸痛中心体外循环科 ,郑州 450008）
Author(s):
LIU Jian-hua; JIANG 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）
关键词:
缺血预处理; 心脏瓣膜置换术; 肝功能; 肾功能; 心肌
Keywords:
ischemic preconditioning;  heart valve replacement;  liver function;  renal function;  myocardium
分类号:
R654.2
DOI:
-
文献标志码:
A
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。
Abstract:
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 HR 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.

参考文献/References:


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备注/Memo

备注/Memo:
基金项目 河南省医学科技攻关计划项目（201402032）
作者简介 刘建华（1973-），女，副主任医师，硕士，研究方向：体外循环；E-mail: 2374903482@qq.com。
更新日期/Last Update: 2018-11-30