短暂缺血预处理对肢体缺血再灌注诱发心肌损伤的保护作用

Protection of Transient Ischemic Preconditioning on Lower Limb Ischemia-reperfusion-induced Myocardial Injury in Human

目的观察短暂缺血预处理对肢体缺血再灌注心肌肌钙蛋白I(cTnI)的影响,探讨围手术期心肌损伤的保护策略。方法将40例拟行下肢骨科手术患者随机分成实验组和对照组,各20例。患者均选用下肢止血带,压力80kPa,持续时间≤90min。对照组采用常规治疗;实验组在常规治疗的基础上采用短暂肢体缺血预处理,即在手术侧大腿根部上止血带,充气5min和放气5min交替进行,充气压力200mmHg,重复3个循环。分别在扎止血带前和松止血带后10min、30min、1h、3h的5个时点采集静脉血2ml检测cTnI,并进行比较。结果两组cTnI在松止血带后10min开始升高,松止血带后1h,cTnI达到最高值,然后逐渐下降。与对照组比较,实验组在松止血带后各时间点的cTnI均明显降低,差异均有统计学意义(P<0.01)。结论短暂缺血预处理对肢体缺血再灌注心肌损伤具有保护作用。

Objective Observed transient ischemic preconditioning on limb ischemia reperfusion myocardial troponin Ⅰ （cTnl） effects on myocardial injury during operation period, protection strategy. Methods 40 patients with lower extremity or-thopedic surgery were randomly divided into two groups, 20 cases in each group. Tourniquet was selected, pressure 80kPa, du-ration time 〈 90 min. Conventional treatment was used in control group. And on the base of control group, transient ischemic preconditioning was used in experimental group. At the operation side thigh tourniquet inflated and deflated, 5min and 5min, 200mmHg inflation pressure, repeating the 3 cycle, eTnI was detected before relaxing tourniquet, 10min, 30min, lh and 3h after relaxing tourniquet. Results Compared with that at before, cTnI at 10min, 30min, lh and 3h increased markedly, and cTnI at lh was the highest value. Compared with that in control group, the Increased range of cTnI at T2 and T3 in experimental group was decreased significantly （P 〈 0. 01 ）. Conclusion Transient ischemic preconditioning can protect lower limb ischemia - reperfusion - induced myocardial injury in human.