幼龄犬胸腔镜体外循环术中抑肽酶的心肌保护作用

Myocardial Protective Effect of Aprotinin in Puppies' Extracorporeal Circulation Cardiac Surgery with Thoracoscope

目的观察幼龄犬胸腔镜体外循环术中、术后心肌损伤情况,以及探讨抑肽酶的心肌保护作用。方法20只幼龄犬,体重10~15 kg,随机分成两组,每组10只,采用经股动脉、股静脉插管后建立体外循环,对照组（A组）不加入抑肽酶;实验组（B组）于转机过程加入抑肽酶4~5万KIU/kg。两组均于麻醉诱导后、主动脉阻断后10min、30min、主动脉开放后30 min,停机后2 h、12 h抽取桡动脉血测定两组血清中CKMB、cTnI、TNF-α、IL-8、IL-10含量。结果两组CKMB、cTnI、TNF-α、IL-8、IL-10主动脉阻断前无明显差别（P〉0.05）;A组在主动脉阻断后均逐渐升高（P〈0.05）,在停机后2 h达高峰,停机后12 h下降,而cTnI持续未见下降;B组与A组相比较除IL-10含量各时间点明显升高外其余均较低,具有统计学意义（P〈0.05）,B组cTnI含量在停机后2 h后出现下降,与A组比较具有显著差异性（P〈0.05）。结论幼龄犬胸腔镜体外循环术后的心肌损伤程度可能以停机后2 h最明显,后未再出现持续性加重。抑肽酶能减轻幼龄犬胸腔镜体外循环术后炎性反应,具有良好的心肌保护作用。

OBJECTIVE To observe the state of myocardial damage and study the myocardial protective effect of aprotinin after extracorporeal circulation of video-assisted thoracoscope operation on puppies. METHODS Twenty puppies with weight from 10 to 15kg were randomly divided into 2 groups according to whether using aprotinin（Group B） or not（Group A） during extracorporeal circulation（ECC）.ECC was set up by the right femoral artery and femoral venous.The radial arterial blood samples were collected at the following time points：after induction of anesthesia,10min and 30 min after aortic clamping,30min after aortic opening,2h and 12h after ECC.The cardiac troponin I（cTnI）,MB isoenzyme of creatine kinase（CKMB）,interleukin-8（IL-8）,tumor necrosis factor-α（TNF-α） and interleukin-10（IL10） were measured.RESULTS There were no significant differences between two groups on the levels of CKMB,cTnI,TNF-α,IL-8 and IL-10 before aortic clamping（P〉0.05）.The concentration of CKMB,cTnI,TNF-α and IL8 gradually raised（P〈0.05） and arrived to the highest level two hours after ECC in group A and then fell.While the persistence of cTnI behaved otherwise,maintaining a high level.But All above mentioned after aortic clamping were significantly higher than that after induction of anesthesia.The level of CKMB,cTnI,TNF-α and IL-8 in group B were lower than that of group A after aortic clamping（P〈0.05）,but IL-10 in group B was remarkably higher（P〈0.05）.The level of cTnI declined at 2h after ECC in group B（P〈0.05）.CONCLUSION Degree of myocardial damage of ECC operation with the video-assisted thoracoscope is conspicuous about two hours after ECC stopping,but does not deteriorate.Aprotinin has satisfactory effect of myocardial protection from the postoperative inflammatory reaction caused by ECC.