远端缺血预处理在成人瓣膜置换术中的心肌保护作用

Effect of Remote Ischemic Preconditioning on Myocardical Injury in Adults Undergoing Valve Replacement Surgery

目的评估远端缺血预处理在成人瓣膜置换术中的心肌保护作用。方法随机选取40例风湿性心脏病需行瓣膜置换术的患者,分为远端预处理组和对照组,每组20例。分别于麻醉诱导前(T0)、停机时(T1)、停机后6小时(T2)和停机后24小时(T3)各时点抽取静脉血,测定血清肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)的浓度。结果远端预处理组T1、T2、T3的cTnI、LDH、TNF-α、IL-1β浓度均显著低于对照组,差异有统计学意义(P<0.05),T2、T3的MDA浓度明显低于对照组,SOD浓度明显高于对照组,差异具有统计学意义(P<0.05)。结论远端缺血预处理可减轻心肌缺血再灌注损伤,促进保护性炎性因子的分泌,有助于缺血再灌注后心功能的恢复及改善。

Objective To investigate whether remote ischaemic preconditioning( RIPC) is beneficial for patients undergoing valve replacement surgery.Methods 40 adult patients undergoing valvular replacement surgery were randomly assigned to either the remote ischemic preconditioning group( n= 20) or to the control group( n= 20).Serum troponin I( cTnI),lactate dehydrogenase( LDH),superoxide dismutase( SOD),malondialdehyde( MDA),tumor necrosis facto-r alpha( TNF-A) and interleukin-1B( IL-1B) concentration were measured before induction of anaesthesia( T0) and at 0( T1),6( T2) and 24 hr( T3) after cardiopulmonary bypass( CPB).Results cTnI,LDH,TNF-Aand IL-1B in the preceonditioning group were significantly reduced compared with the control group( P < 0.05).T2 and T3 of MDA is lower than that of the control patients and SOD is significantly increased( P< 0.05).Conclusions The present study demonstrates that adult patients undergoing valvular replacement surgery could benefit from RIPC.Remote ischemic preconditioning reduces the myocardial ischemia-reperfusion injury,and promotes the secretion of protective inflammatory factors,which is benefit for the recovery of heart function after ischemia-reperfusion.