含乌司他丁自体冷血心脏停搏液对保护心肌细胞的分析

Protective effect of ulinastatin containing autologous cold blood cardioplegia on myocardial cells

目的探讨含乌司他丁自体冷血心脏停搏液对行体外循环室间隔缺损修补术患儿缺血再灌注损伤心肌的保护作用。方法选取2013年1月至2016年3月在上海远大心胸医院行体外循环室间隔缺损修补术的96例患儿,随机分为实验组和对照组。两组均行体外循环室间隔缺损修补术,主动脉阻断过程中实验组使用含乌司他丁自体冷血心脏停搏液在主动脉根部进行灌注,对照组则使用自体冷血心脏停搏液进行灌注,比较两组患儿体外循环情况、心肌细胞凋亡指数和心肌Bcl-2蛋白和Bax蛋白表达。结果主动脉开放10min时,实验组和对照组患儿的心肌细胞凋亡指数均高于体外循环前5min,但实验组患儿的心肌细胞凋亡指数低于对照组,且差异有统计学意义(t=-21.148,P<0.05);主动脉开放10min时,实验组和对照组患儿心肌Bcl-2蛋白和Bax蛋白表达均显著高于体外循环前5min,实验组心肌Bcl-2蛋白优于对照组,且心肌Bax蛋白则低于对照组,差异均有统计学意义(t值分别为34.797、-26.045,均P<0.05)。结论含乌司他丁自体冷血心脏停搏液能减轻行体外循环室间隔缺损修补术患儿缺血再灌注时的心肌损伤,较自体冷血心脏停搏液有更好的保护心肌作用。

Objective To explore the protective effect of ulinastatin containing autologous cold blood cardioplegia on myocardial cells in ischemia-reperfusion myocardium in children treated with ventricular septal defect repair under cardiopulmonary bypass（CPB）.Methods Altogether 96 children treated with ventricular septal defect repair under CPB in Shanghai Yodak Cardiothoriacic Hospital from January 2013 to March 2016 were selected and randomly divided into experimental group and control group.Children in both groups underwent ventricular septal defect repair under CPB.During aortic cross-clamping,ulinastatin containing autologous cold blood cardioplegia was infused into aortic root in experimental group and autologous cold blood cardioplegia was infused into aortic root in control group.Extracorporeal circulation,cardiomyocyte apoptotic index,and myocardial Bcl-2 protein and Bax protein expression were compared in two groups.Results Cardiomyocyte apoptotic index at 10 min after aorta declamping was higher than that at 5 min before establishment of CPB in both experimental group and control group,but cardiomyocyte apoptotic index in experimental group was lower than that in control group with significant difference（t=-21.148,P〈0.05）.Myocardial Bcl-2 protein and Bax protein expression at 10 min after aorta declamping was higher than that at 5 min before establishment of CPB in both experimental group and control group,and myocardial Bcl-2 protein in experimental group was better than that in control group but Bax protein in experimental group was lower than that in control group with significant differences（t value was 34.797 and-26.045,respectively,both P〈0.05）.Conclusion Ulinastatin containing autologous cold blood cardioplegia can reduce myocardial injury during ischemia-reperfusion in ventricular septal defect repair under CPB,which has better protective effect on myocardium than autologous cold blood cardioplegia.