异氟烷预处理对心脏换瓣术患者血MMP-9的影响及其对心肌的保护作用

Isoflurane preconditioning decreases the plasma concentration of matrix metalloproteinase-9 and protects myocardium against cardiopulmonary bypass in cardiac valve replacement

目的:观察异氟烷预处理对体外循环(cardiopulmonary bypass,CPB)心脏换瓣术患者围术期血浆基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)及心肌超微结构的影响,评价其对心肌的保护作用。方法:择期CPB下行瓣膜置换术的心脏瓣膜病患者30例,随机分为异氟烷预处理组(异氟烷组,n=15)和对照组(n=15),异氟烷组在麻醉诱导后CPB前吸入1.1%～1.2%(呼气末浓度)的异氟烷30min,洗脱15min,对照组不吸入异氟烷,其余用药两组无区别。分别于切皮前(T0),主动脉开放30min(T1),6h(T2),12h(T3)及24h(T4)经桡动脉取血测血浆MMP-9浓度,分别于CPB前后取部分右心耳组织电镜下观察超微结构。结果:与T0比较,对照组血浆MMP-9浓度在T1-T3显著增加,异氟烷组血浆MMP-9浓度只在T1显著升高(P<0.01);与对照组比较,异氟烷组血浆MMP-9浓度在T2显著降低(P<0.01),在T1-T3各时点与T0的差值均显著降低(P<0.01)。电镜下可见对照组CPB后心肌细胞损伤比异氟烷组严重。结论:异氟烷预处理能显著抑制心脏换瓣术患者CPB后MMP-9的分泌增多,这可能是其对心脏换瓣术患者心肌保护的机制之一。

Objective To explore the effect of isoflurane preconditioning on the plasma concentration of matrix metalloproteinase(MMP)-9 and myocardial ultramicrostructure in patients undergoing cardiac valve replacement.Methods Thirty patients undergoing elective cardiac valve replacement with cardiopulmonary bypass(CPB) were randomly assigned to a control group(n=15) and an isoflurane group(n=15).In the isoflurane group,isoflurane of 1.0 minimum alveolar concentration end-tidal(1.1%～1.2%) was administered for 30 min ...