局部缺血预处理在冠脉旁路移植术中对右心功能的影响

Effect of regional ischemic preconditioning on right ventricular function in off-pump coronary artery bypass grafting

目的 探讨左冠状动脉前降支 (LAD)局部缺血预处理 (rIP)在非体外循环冠脉旁路移植术 (OPCAB)中对右心功能的保护作用。方法 rIP组在首支冠脉吻合前采用 2轮LADrIP :首轮为 2min缺血 3min再灌注 ,第 2轮为 5min缺血 5min再灌注 ,比较两组右心功能。结果 术后所有反映右心功能的各项指标 ,包括中心静脉压、平均肺动脉压、右室射血分数、右室舒张末期容积指数以及右室作功指数两组之间均无明显差异。术后对照组肺循环阻力有逐渐增加的趋势 ,rIP组仅术后 6h趋于增加 ;术后第 1天对照组肺循环阻力倾向高于rIP组 (P =0 .0 8)。结论 OPCAB时LAD 2轮rIP :首轮为 2min缺血 3min再灌注 ,第 2轮为 5min缺血 5min再灌注 ,对右心功能无明显保护作用。

Objective To investigate whether regional ischemic preconditioning (rIP) ofleft anterior descending coronary artery (LAD) could offer myocardial protection on right ventricular function in patients undergoing elective off-pump coronary artery bypass surgery. Methods Nineteen patients with preceding rIP were compared with 17 patients without it. The rIP group underwent two additional myocardial regional ischemia of LAD at the beginning of revascularization operation before the ischemic period used for the first coronary artery bypass graft distal anastomosis: a 2-minute period of ischemic followed by a 3-minute reperfusion period, and then a 5-minute period of ischemia followed by a 5-min reperfusion period. Results There was no statistical significant regarding all parameters of right ventricular function, including central venous pressure, mean pulmonary artery pressure, right ventricular ejection fraction, right ventricular end diastolic volume index and right ventricular stroke work index, perioperatively. After operation, the pulmonary vascular resistance index had a tendency to gradually increase in the control group, and on the first postoperative day it tended to be lower in rIP group than in control group (P=0.08). Conclusions The two cycles of regional 2 min rIP followed by 3 min reperfusion, and then 5 min rIP followed by 5 min reperfusion on the LAD are proved unable tooffer myocardial protection on right ventricular function in patients undergoingelective off-pump coronary artery bypass surgery.