心脏跳动中二尖瓣置换术心肌细胞凋亡的临床研究

A clinical study on cardiac myocyte apoptosis in beating heart mitral valve replacement

目的检测心脏跳动中二尖瓣置换术患者心肌细胞凋亡情况。方法将同期30例风心二尖瓣膜疾病患者随机分为实验组(浅低温心脏跳动中施术组)与对照组(中低温传统停跳施术组)。分别于心肺转流术(CPB)前,停机时留取右心房肌标本,采用原位细胞凋亡检测试剂盒,扫描电镜检测心肌细胞的细胞凋亡情况。结果与CPB前比较,对照组CPB后心房肌细胞凋亡指数明显升高(P<0.01);而实验组CPB前、后心肌细胞凋亡指数差异无显著性(P>0.05);CPB后,实验组心肌细胞凋亡指数较对照组明显降低(P<0.01)。结论在心脏跳动中二尖瓣置换术心肌细胞的细胞凋亡指数明显低于传统停跳手术组,说明心脏跳动中施术对心肌细胞的缺血和再灌注损伤要比传统停跳手术小。

Objective To investigate the apoptosis of the cardiac myocyte in mitral valve replacement while heart beating. Methods 30 patients with rheumatic mitral valvular heart diseases were divided into two groups： 15 patients in experimental group （aorta unclamped and mild hypothermia） and 15 ones in control group （aorta cross- clamped and moderate hypothermia）. Samples of the right atrial were obtained before and after cardiopulmonary bypass （CPB） and the myocyte apotosis were examed via TUNEL reagents boxes and scanning electron microscopy. Results Compared to pre - CPB, myocyte apoptosis in control group increased significantly after CPB （ P 〈 0.01）, while those in the experimental group showed no significant differences before and after CPB （ P with control group, myocyte apoptosis decreased significantly after CPB in experimental group（ clusion The myocyte apoptosis in heart beating mitral valve replacement is apparently less than rest, which indicates myocyte ischemia and reperfusion iniurv induced bv heart beating surgery is less than that in traditional heart stop- beating.