心脏瓣膜置换术中高氧液预处理对患者心肌酶学的影响

Effect of Hyperoxia Liquid Preconditioning on Myocardial Enzyme During Valve Replacement

目的研究高氧液预处理对心脏瓣膜置换手术患者缺血-再灌注心肌酶学的影响。方法将40例择期心脏瓣膜置换术患者随机分成观察组和对照组,每组20例。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(HB-DH)含量。结果与T0时比较,两组T1、T2、T3时心肌酶值均增高(P<0.05或<0.01)。T1时,观察组CK、HBDH低于对照组(P<0.01或<0.05);T2、T3时,观察组LDH、CK、CK-MB明显低于对照组(P<0.01或<0.05)。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 effects of hyperoxia liquid preconditioning on myocardial en-zyme in patients undergoing heart valve replacement. Methods Forty patients were randomly divided in- to hyperoxia liquid group（group HL） and control group（group C） with 20 cases each. The patients were given 10ml/kg Ringer＇s injection（group C） or 10ml/kg hyperoxia liquid（group HL） respectively. The central venous blood samples were collected in both groups before skin incision（T0）, at lh after start of CPB（T1）, 2h（Tz） and 24h（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）. Results Compared with To, LDH, CK, CK-MB and HBDH were all higher at T1, T2 and T3 （P〈0.05 or 〈0.01）. Compared with group C, a significant decrease of CK, HBDH in group HL was noted at T1 （P〈0.05 or 〈0.01）. Compared with group C, a obvious decrease of LDH. Ck.CK-MB in group HL was noted at T2,T3 （P〈0.05 or 〈0.01）. Conclusion Hyperoxia liquid pre-conditioning may attenuate myocardial ischemia reperfusion iniury.