婴幼儿肢体缺血预处理及对血管内皮功能的影响

The effects of remote ischemic preconditioning of endothelial function in infants

目的探索婴幼儿远隔部位缺血预处理(Remote Ischemic Preconditioning RIPC)的实施方案及对血管内皮功能的影响。方法将40例体重7kg以下的先天性心脏病婴幼儿随机分为预处理组和对照组,预处理组在左上肢以血压计袖带实施RIPC,以血管超声监测右上肢肱动脉血流介导内皮舒张(Flow Mediated Dilation,FMD)功能。结果RIPC实施顺利,无并发症;预处理组基础FMD无明显差别,经缺血再灌注后FMD明显下降,对照组为(8.90±2.12)%,明显低于预处理组的(12.33±2.45)%,P<0.05,差异有统计学意义。结论RIPC可安全应用于婴幼儿,并能明显影响其血管内皮功能。

Objective To find a way for carrying remote isehemic preconditioning （RIPC） and to study the effects of RIPC of endothelial function in infants. Methods 40 infants weight less than 7 kilograms were divided into two groups randomly （control group and preconditioning group, 20 cases for each group）. The basic endothelial flmctions in the form of flow-mediated dilalion （FMD） on right upper arms＇ brachial artery in both groups were assessed by high resolution uhrasound. Then the patients in the preconditioning group were remotely preconditioned on the left upper arms with three cycles of 3 rain ischemia and 3 min reperfusion; while the palients in control group were not preconditioned. After 20 minutes, isehemie （keeping inflation of tourniquet to 240 mmHg for 15min） and repeffusion （keeping deflation of tourniquet for 15min） was done on the contralaleral limb in both groups, the FMD was re-checked at the same manner. Results The RIPC were carried without any complications. The basic FMD in both groups were not different which were decreased significantly after the ischemia-repeffnsion. After the ischemia-repeffusion, the FMD in the preconditioning group was （12.33 ± 2.45）%, while in the control group was （8.90 ± 2.12）%, which lower than the preconditioning group significantly （P 〈 0.05）. Conclusions The RIPC on upper arm can be carried safely in infants and can alleviate endothelial ischemia-reperfusion injury.