摘要
【目的】观察远隔缺血预处理对心脏瓣膜置换患者急性肾损伤的影响。【方法】本院择期行心脏瓣膜置换患者60例,随机分为两组：远隔缺血预处理组（R组）和对照组（C组）,每组30例。R组在麻醉诱导后对患者右下肢实施3周期5 min 缺血/5 min 再灌注处理,C 组不进行该处理。分别于术前（T0）、体外循环（CPB）后2 h （T1）、6 h（T2）、24 h（T3）、48 h（T4）、72 h（T5）6个时间点检测患者血浆嗜中性粒细胞明胶酶相关脂质运载蛋白（NAGL）和胱抑素C（Cystatin C,Cys C）、血肌酐（SCr）浓度。记录比较患者术后拔管时间、ICU 停留时间及急性肾损伤发生率。【结果】与T0比较,两组血浆 NAGL、Cys C在T2、T3、T4时升高,SCr 在 T4时升高,且差异有显著性（P ＜0.05）。与C组相比,R组血浆 NAGL、Cys C 浓度在 T2、T3、T4、T5时较低,SCr 在 T4、T5时较低,术后急性肾损伤发生率降低、拔管时间和 ICU停留时间缩短,且两组相比较差异有显著性（P ＜0.05）。【结论】远隔缺血预处理可减轻心脏瓣膜置换患者急性肾损伤。
[Obj ective]To observe the effects of remote ischemic preconditioning on acute kidney inj ury in pa-tients undergoing valve replacement surgery with cardiopulmonary bypass（CPB）.[Methods]A total of 60 patients scheduled for valve replacement with CPB were randomized into 2 groups of remote ischemic preconditioning （R） and control （C）（n=30 each）.They were assigned by a random number generator to receive placebo or 3 cycles of 5-min ischemia and 5-min reperfusion on right lower extremity immediately after anesthesia via a tourniquet. The levels of plasma neutrophil gelatinase-associated lipocalin （NGAL）,cystatin C （Cys C）and creatinine （SCr） were detected before surgery and at 2,6,24,48 and 72 h after termination of CPB （T0～T5 ）.The extubation time,length of intensive care unit （ICU）stay and incidence of acute kidney inj ury were recorded.[Results]Com-pared with group C,the levels of plasma NGAL and Cys C significantly decreased at T2 ,T3 ,T4 and T5 ,SCr sig-nificantly decreased at T4 ,and T5 .the postoperative incidence of acute kidney inj ury decreased and the extubation time and length of ICU were obviously shortened in group R （P 〈0.05）.Compared with T0,plasma NGAL and Cys C at T2 ,T3 and T4 significantly increased and SCr at T4 obviously increased in two groups（P 〈0.05）.[Con-clusion]Remote ischemic preconditioning can reduce acute kidney inj ury in patients undergoing valve replacement.
出处
《医学临床研究》
CAS
2015年第8期1604-1606,1609,共4页
Journal of Clinical Research
