远隔缺血时处理对瓣膜置换手术患者的心肾保护作用

Protective Effect of Remote Ischemia Preconditioning on Myocardium and Kidney in Patients Undergoing Valve Replacement

【目的】观察远隔缺血时处理在风湿性心脏病瓣膜置换手术中对患者心脏和肾脏的保护作用。【方法】选取风湿性心脏病行瓣膜置换术的患者80例，将其随机分为对照组（A组）和远隔缺血时处理组（B组），每组40例。B组于体外循环主动脉阻断后对患者右下肢大腿（距离膝关节2～3 cm），以止血带施以压力600 mmHg ，持续5 min ，松开气囊5 min ，重复以上过程3次。分别于术前（T1），开放主动脉前5 min（T2），开放主动脉后30 min （T3），主动脉开放后4 h（T4），和24 h（T5），抽取静脉血测定肌钙蛋白I （cTnI），B型钠尿肽（BNP），尿素氮（BUN），肌酐（SCr），急性肾损伤因子（kim-1）。【结果】两组病例在年龄，质量，体外循环转流时间，主动脉阻断时间以及术前cTnI ，BNP ，BUN ，SCr ，Kim-1无统计学上差别（P＞0．05），具有可比性。与T1比较，两组的cTnI在T3，T4，T5较术前有显著性升高；与A组相比，B组有显著性下降（P＜0．05）。两组的BNP在T5较术前有显著性升高；与A组相比，B组有显著性下降（P＜0．05）。两组的BUN和Scr在T5较术前有显著性升高；与A组相比，B组有显著性下降（ P＜0．05）。两组的Kim-1在T4，T5较术前有显著性升高；与A组相比，B组有显著性下降（P＜0．05）。【结论】远隔缺血时处理对于风湿性心脏病行瓣膜置换手术的患者的心脏和肾脏功能有保护作用。

[Objective]To observe the protective effect of remote ischemia preconditioning on myocardium and kidney of patients with rheumatic heart disease during valve replacement .[Methods]A total of 80 patients with rheumatic heart disease undergoing valve replacement were chosen and randomly divided into control group（group A ,n=40） and remote ischemia preconditioning group（group B ,n =40） .In group B ,the right thighs（2～3cm near knee joint） of patients were given 600mmHg pressure by tourniquet for 5min after aortic clamping under cardiopulmonary bypass ,and then the balloon was unclamped for 5min .The cycle was repeated for 3 times .Venous blood samples were drawn to measure troponin I （cTnI） ,B-type natriuretic peptide （BNP）,urea nitrogen（BUN）,serum creatinine（Scr） and acute renal injury factor（Kim-1） before surgery （T1 ） ,5min before aortic declamping（T2 ） ,30min（T3 ） ,4h（T4 ） and 24h（T5 ）after aortic declamping .[Results]There was no significant difference in age ,weight ,cardiopulmonary bypass time ,aortic clamping time and preoperative cTnI ,BNP ,BUN ,Scr and Kim-1 between two groups（ P〉0 .05） with comparability .Compared with T1 ,the cTnI in two groups at T3 ,T4 and T5 were increased significantly ,while those in group B were significantly lower than those in group B （ P 〈 0 .05） .Compared before operation ,the BNP in two groups at T5 was increased significantly ,while that in group B was significantly lower than that in group A （ P〈0 .05） .Compared with before operation ,BUN and Scr in two groups at T5 were increased significantly ,and those in group B were significantly lower than those in group A （ P〈0 .05） .Compared with before operation , Kim-1 in two groups at T4 and T5 was increased significantly ,and that in group B was significantly lower than that in group B（ P 〈0 .05） .[Conclusion]Remote ischemic preconditioning can protect the myocardial and renal function in patients with rheumatic heart disease undergoing valve replacement .