远隔缺血时处理对体外循环心脏瓣膜置换术患者全身炎性反应的影响

Effect of remote ischemic perconditioning on systemic inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass

目的评价远隔缺血时处理对体外循环（CPB）心脏瓣膜置换术患者全身炎性反应的影响。方法择期CPB心脏瓣膜置换术患者40例，年龄40～64岁，体重50～70kg，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将其分为2组（n=20）：对照组（c组）、远隔缺血时处理组（R组）。R组于主动脉阻断后对右下肢实施3周期5min缺血／5min再灌注处理。于CPB前即刻、CPB结束后即刻、6、24h（T1-4）时取右颈内静脉血样，检测血清细胞间粘附分子-1（ICAM-1）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF—α）的浓度。结果与c组比较，R组血清ICAM-1、IL-6、TNF-α浓度降低（P〈0．05）。与T1时比较，两组T2-3时血清ICAM-1、IL-6、TNF—d浓度升高，C组T4时血清ICAM-1、IL-6浓度升高，R组T4时血清IL-6浓度升高（P〈0．05）；与T2时比较，两组T3.4时血清ICAM-1、IL-6、TNF．d浓度降低（P〈0．05）；与T3时比较，两组T4时血清ICAM-1、IL-6、TNF-α浓度降低（P〈0．05）。结论远隔缺血时处理可减轻CPB心脏瓣膜置换术患者全身炎性反应。

Objective To evaluate the effect of remote ischemic perconditioning on systemic inflammatory response in the patients undergoing cardiac valve replacement with cardiopulmonary bypass （ CPB ）. Methods Forty adult patients undergoing cardiac valve replacement under CPB were randomly divided into 2 groups （ n = 20 each）： control group （group C） and remote ischemic preconditioning group （group R）. Anesthesia was induced with iv injection of midazolam, fentanyl, vecuronium. The patients were mechanically ventilated after endotracheal intubation. Anesthesia was maintained with iv injection of midazolam, fentanyl, vecuronium and inhalation of sevoflurane. Three cycles of 5-min ischemia and 5-min reperfusion were performed on the right lower extremity im- mediately after aortic occlusion by means of a tourniquet in group R. A tourniquet was only placed under the right lower extremity in group C. Before CPB and at 0, 6 and 24 h after termination of CPB （T1.4）, blood samples were obtained from the right internal jugular vein for determination of levels of serum intercellular adhesion molecule-1 （ICAM-1）, IL-6 and TNF-α. Results The levels of serum ICAM-1, IL-6 and TNF-α were significantly lower in group R than in group C （ P 〈 0.05）. Compared with the baseline value at T1, the levels of serum ICAM-1, IL-6 and TNF-a were significantly increased at T2 and T3 in both groups, serum ICAM-1 and IL-6 levels were increased at T4 in group C, while serum IL-6 level was increased at T4 in group R （ P 〈 0.05）. The levels of serum ICAM- 1, IL-6 and TNF-α were significantly decreased at T3 and T4 than at T2 in both group （P 〈 0.05）. The levels of serum ICAM-1, IL-6 and TNF-α were significantly lower at T4 than at T3 in both groups （ P 〈 0.05）. Conclusion Remote ischemic perconditioning can alleviate the systemic inflammatory response in patients undergoing cardiac valve replacement with CPB.