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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-huaJIANG WeiSHI GuangLIANG Qiao-ruYAN 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:


[1] 叶明,吴辉. 心肌缺血再灌注损伤的研究新进展[J]. 中华老年心脑血管病杂志, 2016, 18(4):434
[2] 朱丽, 陈莹莹, 罗亮春,等. 心脏瓣膜置换术后患者抗凝治疗的个案管理[J]. 护理学杂志, 2015, 30(16):27
[3] 张登沈,梁贵友, 刘达兴,等. 心脏瓣膜置换术后早期死亡原因及相关因素分析[J]. 临床心血管病杂志, 2015,31(8):874
[4] 吴晓燕, 苗琳, 郑蕊,等. 心肌缺血再灌注损伤的研究进展[J]. 中国临床药理学杂志, 2016, 32(11):1043
[5] 乔钰惠, 孟增慧, 郭丽君,等. 心肌缺血再灌注损伤的机制和治疗[J]. 基础医学与临床, 2015, 35(12):1666
[6] 李冀, 丁莹, 王呈祥,等. 浅谈心肌缺血再灌注损伤的中医新进展[J]. 中医药学报, 2016, 44(2):105
[7] Dayton C, Yamaguchi T, Warren A, et al. Ischemic preconditioning prevents postischemic arteriolar, capillary, and postcapillary venular dysfunction: signaling pathways mediating the adaptive metamorphosis to a protected phenotype in preconditioned endothelium[J]. Microcirculation, 2015, 9(2):73
[8] Gallagher S M, Dan A J, Kapur A, et al. Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery[J]. Kidney Int , 2015, 87(2):473
[9] Krogstad L E. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery[J]. New Engl J Med , 2015, 373(15):1397
[10] 许静红, 肖亮灿, 徐夏,等. 右美托咪定用于中老年患者体外循环下心脏瓣膜置换手术心肌保护作用的评估[J]. 实用医学杂志, 2015, 31(23):3938
[11] Hausenloy D J, Candilio L, Evans R, et al. Remote ischemic preconditioning and outcomes of cardiac surgery[J]. New Engl J Med, 2015, 373(15):1408
[12] Mccrindle B W, Clarizia N A, Khaikin S, et al. Remote ischemic preconditioning in children undergoing cardiac surgery with cardiopulmonary bypass: a single-center double-blinded randomized trial[J]. J Am Heart Associat, 2014, 3(4):A11013
[13] Felker G M, Mentz R J, Teerlink J R, et al. Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX‐AHF study[J]. Eur J Heart Fail, 2016, 17(12):1262
[14] Carlsson A C, Bandstein N, Roos A, et al. High-sensitivity cardiac troponin T levels in the emergency department in patients with chest pain but no myocardial infarction[J]. Int J Cardiol , 2017, 228(13):253
[15] 王艳华, 苏文利, 郝平,等. p55TNFR选择性淋巴毒素对大鼠缺血再灌注后心脏损伤的保护作用[J]. 中华急诊医学杂志, 2015, 24(10):1131

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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