缺血预处理在冠状动脉搭桥术中对心肌的保护作用

The protection of ischaemic preconditioning(IPC) on open heart surgery in CAD patients

目的 :探讨缺血预处理 (Ischaemicpreconditioning ,IPC)在冠状动脉搭桥 (Coronaryarterydis ease ,CAD)手术中是否能有效的降低心肌细胞的损伤达到良好的心肌保护作用。方法 :将 2 4例均为三支病变、稳定心绞痛、首次进行搭桥患者随机分成 2组 :缺血预处理组 (I组 ) ;对照组 (C组 ) ;I组是于冷血停跳液诱导心脏停跳前给予心肌 2个循环的缺血 (2min)和再灌注 (3min) ;C组在应用冷血停跳液诱导心脏停跳前给予心脏并行辅助循环 10min ,术中每间隔 30min灌注一次心肌停搏液。在观察临床结果的同时 ,并于麻醉诱导后、术毕、术后 8～ 12h、2 4h、72h和 6d分别抽取静脉血测定血浆中肌酸激酶(CK MBmass)、肌钙蛋白I(TnI)的水平。结果 :在 2组中的术前及术后的临床指标没有明显差异。 1 I组的自动复跳率 (10 0 % )明显高于C组 (5 8% ) (P <0 0 5 ) ;2 cTNI和CK Mbmass的水平从术后 6h开始升高(P <0 0 5 ) ,在 2 4～ 72h达到峰值 ,在术后第 6d基本恢复。与C组比较I组在术后 6h、2 4h和 72h的血浆cTNI和CK Mbmass的水平明显降低 (P <0 0 1)。结论 :缺血预处理在心脏外科中的应用是安全的 ;同时通过监测肌钙蛋白I的释放 ,多次短时间的缺血预处理在低危冠状动脉搭桥患者中较常规方法更有利于缺血心肌的心肌保护?

Objective: To investigate whether ischaemic preconditioning(IPC) could reduce myocardial injury and supply a good protection to the myocardium. Method: Twenty-four patients with three vessel coronary artery disease(CAD) and stable angina received for first time elective coronary artery bypass surgery were randomly divided into two groups:Group of ischaemic preconditioning(IPC) n =12;Group of control ( n =12).In group I the patients received two circles of ischemia(2 min) and reperfusion(3 min) before myocardium arrest induced by cool blood cardioplegia.Group C patients received routine method.Clinical outcomes was observed during operation and after operation.Blood sample was taken from venous at pre-bypass and post-bypass time to measure creatine kinase(CK-MBmass),troponin I(TnI).Result:In both groups,there were no differences regarding operative parameters.CK-Mbmass,cTnI release in group of control were higher than those in group I( P <0.01).Conclusion:The method of ishcaemic preconditioning is safe during heart surgery and has a good protection on open heart surgery in CABG.