摘要
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.
出处
《心血管康复医学杂志》
CAS
2009年第3期201-204,共4页
Chinese Journal of Cardiovascular Rehabilitation Medicine
基金
全军卫生科研基金资助(No2006Q022)