高氧液预处理对心脏瓣膜置换术患者心肌肌钙蛋白Ⅰ和心肌酶学的影响

Effect of hyperoxia liquid preconditioning on myocardial enzyme and cardiac troponin Ⅰ during value replacement

目的观察高氧液预处理对心脏瓣膜置换手术患者缺血-再灌注心肌的保护作用。方法将30例择期心脏瓣膜置换术患者随机分成观察组和对照组。对照组患者在麻醉后切皮前(T0)至心肺转流(CPB)开始后10min,静滴复方氯化钠注射液10ml/kg;观察组给予相等容量的高氧液。分别于T0、CPB开始后1h(T1)、主动脉开放后2h(T2)、24h(T3)测定乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、α-羟丁酸脱氢酶(HBDH)和心肌肌钙蛋白Ⅰ(cTnI)。结果与T0时比较,两组T1、T2、T3时心肌酶和cTnI测定值均增高(P<0.05)。两组间比较,LDH、CK-MB在T2、T3时,CK和cTnI在T1、T2、T3时,HBDH在T1时,观察组明显低于对照组(P<0.05)。术后24h多巴胺用量,观察组明显低于对照组(P<0.01)。结论高氧液预处理能减轻心肌缺血-再灌注损伤后酶学改变。

Objective To observe the cardioprotective effects of hyperoxia liquid preconditioning in patients undergoing heart valve replacement. Methods Thirty patients were randomly divided into hyperoxia liquid group（group H L） and control group （group C） with 15 cases each. The patients were given 10ml/kg Ringer＇s injection （group C） or 10 ml/kg hyperoxia liquid （group HL） respectively. The central venous blood samples were collected in both groups before skin incision （T0）, at 1 h after start of CPB（T1 ）, 2 h（T2）and 24 h（T3 ） after aorta off-clamping for detecting the blood concentrations of lactate dehydrogenase （LDH）, creatine kinase （CK）, creatine kinase-MB （CK-MB）, α-Hydrobutyric dehydrogenase（HBDH） and cTnI. Results Compared with To, LDH,CK,CK-MB, HBDH and cTnI were all higher at T1, T2 and T3 （P〈0.05）. Compared with group C, a significant decrease of LDH and CK-MB in group HL was noted at T2 and T3 （P〈0.05）. cTnI and CK of group C were obviously higher than those of group HL at all other time points （P〈0.05）. Compared with group C, a obvious decrease of HBDH in group HL was noted at T1 （P〈0. 05）. The amount of dopa mine in group C was higher than that of group HL after aorta off-clamping within 24 hours（P〈0.01）. Conclusion Hyperoxia liquid preconditioning may attenuate myocardial ischemia reperfusion injury.