甲状腺激素对体外循环下瓣膜置换术中心肌及脑组织缺血再灌注损伤的影响

Effect of euthyrox on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass

目的:探讨甲状腺激素(优甲乐)对体外循环下瓣膜置换术中心肌及脑组织缺血再灌注损伤的影响。方法:收集2013年1月~2016年12月间在本院接受体外循环下瓣膜置换术的患者76例,按照随机数表法分为观察组、对照组各38例。观察组患者术前1周口服左甲状腺素钠片(优甲乐)50μg/d至手术日早晨,对照组患者在相同时间点口服安慰剂(维生素C),1片/d至手术日早晨,均持续1周。对比两组患者服药前、体外循环后(手术结束前)血清中心肌酶谱指标、神经损伤指标含量的差异。结果:服药前,两组患者血清中心肌酶谱指标、神经损伤指标含量的差异无统计学意义(P>0.05)。体外循环后,观察组患者血清中心肌酶谱指标肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBD)、血清乳酸脱氢酶(LDH)的含量均低于对照组(P<0.05);血清中神经损伤指标神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、神经细丝酸性蛋白(GFAP)含量均低于对照组(P<0.05),碱性成纤维细胞生长因子(bFGF)的含量高于对照组(P<0.05)。结论:体外循环下瓣膜置换术中甲状腺激素干预,可有效减轻心肌及脑组织的缺血再灌注损伤程度。

Objective：To study the effect of euthyrox on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass.Methods：A total of 76 patients who received valve replacement under cardiopulmonary bypass in our hospital between January 2013 and December 2016 were collected and divided into control group（n=38）and observation group（n=38）according to random number table.One week before surgery,patients in observation group took euthyrox orally（50μg/d）,while patients in control group took vitamin C tablets（1tablet/d）,and both therapies lasted for 1week until the morning of surgery day.Before medication and after cardiopulmonary bypass（before the end of surgery）,serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were compared between the two groups of patients.Results：Before medication,differences in the serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were not statistically significant between the two groups of patients（P〈0.05）.After cardiopulmonary bypass,serum myocardial enzyme spectrum indexes cTnT,CK-MB,α-HBD and LDH levels in observation group were significantly lower than those in control group;serum nerve injury indexes NSE,S100 Band GFAP levels were lower than those in control group while bFGF level was significantly higher than that in control group（P〈0.05）.Conclusions：Euthyrox intervention in valve replacement under cardiopulmonary bypass can effectively reduce the myocardial and cerebral ischemia reperfusion injury.