远程预处理对非体外循环冠脉旁路移植术心肌酶谱及肌钙蛋白T的影响

Effect of remote preconditioning on changes of myocardial zymogram and cardiac troponin T after coronary bypass grafting without cardiopulmonary bypass

目的:通过心肌酶谱和肌钙蛋白的变化,研究远程预处理(RPC)对非体外循环冠脉旁路移植手术(CABG)心肌损伤程度的影响。方法:20例患者被随机分为RPC组和对照组,每组10例。RPC组吻合血管前1h,以充气式压力止血带环扎双下肢大腿上1/3施压(压力200 mmHg,循环两次,每次10 min,间隔10 min),预处理后再灌注30 min,吻合冠状动脉前降支。对照组处理同RPC组,但止血带不充气。分别于手术开始前和手术开始后2h,6h,24h,48h,72h,96h等7个时间点抽取静脉血检测肌酸磷酸激酶及其同工酶(CK-MB),肌钙蛋白T(cTnT)。结果:术后对照组的CK及CK-MB峰值[(335.8±71.9)U/L,(47.5±17.8)U/L]明显高于RPC组的(280±112)U/L,(27.6±7.3)U/L;对照组cTnT在术后6h达峰值[(1.79±0.08)ng/ml],较RPC组峰浓度[(1.35±0.17)ng/ml]显著升高(P均<0.01)。结论:非体外循环CABG围术期远程预处理对CABG心肌缺血再灌注损伤具有一定的保护作用。

Objective： To study the effect of remote preconditioning （RPC） on changes of myocardial zymogram and serum troponin T concentration after coronary artery bypass grafting （CABG） without cardiopulmonary bypass, Methods： Twenty patients were randomly divided into 2 groups （n= 10 all） ： Control group, received no treatment except CABG; In remote preconditioning group, patients received transient hindlimb ischemia-reperfusion by 10 min each times （inflation of a blood pressure cuff to 200 mmHg, 2 times） followed by reperfusion 30 rain. Then the phospho-creatine kinase （CK） and its isodynamic enzyme （CK-MI3）, serum troponin T （cTnT） were determined from blood by vena jugularis interna before operation and after at 2h, 6h, 24h, 48h, 72h, 96h and 120h after reperfusion. Results： The maximum score of cTnT after reperfusion was higher in control group than that of RPC group （1.79±0.08） ng/ml, （1.35±0.17） ng/ml, P〈0.01. The CK and its isodynamic enzyme CK-HB levels of control group were also more than those of RPC group after reperfusion [（335.8±71.9） U/L, （47.5±17.8） U/L： （280±112） U/L, （27.6±7.3） U/L, P〈0.05 all]. Conclusion： In the operation of coronary artery bypass grafting without cardiopulmonary bypass, RPC can induce ischemia tolerence against myocardial ischemia reperfusion injury.