不同灌注方法心脏术后心肌型脂肪酸结合蛋白水平的变化及意义

Changes of heart fatty acid-binding protein concentrations after open heart surgery with different cardioplegia perfusion methods

目的探讨不同灌注方法体外循环心脏术后外周血中心肌型脂肪酸结合蛋白的变化及意义。方法选择先天性心脏病患者40例，按入院顺序以奇偶数随机分为晶体停搏液组和含血停搏液组2组，每组20例。测定麻醉诱导前、体外循环结束后不同时间点外周血心肌型脂肪酸结合蛋白（H—FABP）的浓度。结果2组间H—FABP的术前水平无差异，2组患者术后血清H—FABP水平均不同程度升高，于体外循环结束后1h达峰值[晶体停搏液组（50．13±3．98）μg／L，含血停搏液组（39．27±4．22）μg/L]，冷晶停搏液灌注组升高更明显（P〈0．05）。在体外循环结束后24h逐渐下降趋于术前水平，但术中及术后各时点的水平冷晶体组均高于冷血灌注组。体外循环结束后1hH．FABP水平与体外循环主动脉阻断时间呈正相关（晶体停搏液组r=0．901，含血停搏液组r=0．673，均P〈0．01）。结论体外循环心脏术后H-FABP显著升高，峰值浓度出现早，可作为一项早期判断心肌损伤的敏感实验指标。升高的程度与心肌损伤程度有关，与主动脉阻断时间有关。灌注含血停搏液可明显减轻心肌损伤，减少H—FABP的释放，与灌注晶体停搏液相比，含血停搏液有良好的心肌保护作用。

Objective To observe the changes of plasma heart fatty acid-binding protein （H-FABP） after open heart surgeries with different cardioplegia perfusion methods. Methods Forty congenital heart disease（CHD） patients underwent cardiac operation were randomly divided into two groups： cold crystalloid cardioplegia perfusion group （Ⅰ,20 cases） and cold blood cardioplegia perfnsion group（Ⅱ,20 cases）. The plasma H-FABP concentration was detected by Enzyme-linked immunosorbent assay （ELISA） before and at different time points after CPB. Results The difference of plasma concentration of H-FABP preoperative was not significant between group Ⅰ and group Ⅱ. In both groups the plasma concentration of H-FABP during and after operation was higher than that before anesthesia. Conclusion Postoperative H-FABP concentration is significantly higher than preoperative H-FABP concentration. The level of plasma H-FABP concentration is not only related to the degree of myocardial damage but also related to the duration of aortic cross-clamping. H-FABP is a sensitive index for myocardial damage.