不同肢体远隔缺血后处理方法对瓣膜置换术患者血清心肌肌钙蛋白T浓度及术后恢复的影响

Effects of different limbs remote ischemic postconditioning on serum concentration of cardiac troponin T and postoperative recovery in patients undergoing valve replacement

目的观察上、下肢体缺血后处理两种处理方法对瓣膜置换术患者血清心肌肌钙蛋白T(c Tn T)浓度及术后恢复的影响,探讨不同的肢体远隔缺血后处理模式的心肌保护效果。方法将48例风湿病瓣膜病患者均分为对照组(C组)、上肢缺血后处理组(S组)、下肢缺血后处理组(X组),均在体外循环直视下行心脏瓣膜置换术。分别在S组患者的右上臂、X组患者的左大腿系止血带,在体外循环期间、主动脉开放前30 min内,将S及X组的止血带充气保持阻断3 min后复流3 min,重复3次;C组对上、下肢体不做任何处理。分别于麻醉诱导后即刻(T1),主动脉开放后2 h(T2)、12 h(T3)、24 h(T4)、36 h(T5)检测血清c Tn T的浓度,记录术后血管活性药物使用的时间、拔出气管导管时间、呼吸机辅助呼吸时间、术后ICU停留时间、住院时间等。结果在各时间点,S组及X组的c Tn T水平均低于C组(P<0.05),S组及X组比较,差异无统计学意义(P>0.05);各组的c Tn T水平有随时间变化而变化的趋势(P<0.05)。S组及X组患者术后ICU停留时间、血管活性药物使用时间、呼吸机辅助呼吸时间、拔出气管导管时间、术后住院时间均短于C组(P<0.05),S组及X组间比较,差异无统计学意义(P>0.05)。结论两种远隔缺血后处理方式能降低术中及术后血清c Tn T的浓度,缩短术后恢复的时间。

Objective To observe the effects of upper and lower limbs ischemic postconditionings on the serum concentration of cardiac troponin T（cTnT） and postoperative recovery in patients undergoing valve replacement, thus to explore the efficacy of different limbs remote ischemic postconditioning on myocardial protection. Methods Forty-eight patients with rheumatic valvular disease were equally divided into control group（ Group C）, upper limb ischemic postconditioning group （Group S） and lower limb ischemic postconditioning group（ Group X） ,and all patients received valve replacement under cardiopulmonary bypass. Tourniquets were fastened to the right upper arms of the patients in Group S,and to the left thighs of the patients in Group X. During the cardiopulmonary bypass and within 30 minutes before aorta declamping,tbe tourniquet was inflated to block for 3 minutes,and then was deflated to reperfuse for 3 minutes in Group S and Group X. The above process repeated 3 times. No special treatment was performed on upper and lower limbs in Group C. The serum concentrations of cTnT were detected in all patients at the instance of anesthesia induction finished （ T1 ） , at 2 hours （ T2 ） , 12 hours （ T3 ） ,24 hours （ T4 ） and 36 hours （ T5 ） after aorta declamping. And the time of using vasoactive agent after operation,the time of extubation ,the time of ventilator-assisted breathing,postoperative ICU stay and hospital stay were observed. Results At each time point,the serum concentration of cTnT in Group S or Group X was lower than that in Group C（P 〈0.05）,but there was no statistical difference between Group S and Group X（P 〉0. 05）. The cTnT level changed over time in each group（P 〈0.05 ）. The postoperative ICU stay ,the time of using vasoactive agent,the time of extubation,the time of ventilator-assisted breathing and postoperative hospital stay were shorter in Group S or Group X compared to those in Group C （P 〈 0. 05） ,but no statistical difference was found between Group S and Group X （P 〉 0. 05 ）. Conclusion Both remote ischemic postconditionings can reduce the intraoperative and postoperative levels of serum cTnT ,and shorten the time of postoperative recovery.