远端缺血预处理对胸腔镜下心脏手术ATP酶的影响

Effects of remote ischemic preconditioning on ATP emzyme in thoracoscopic heart operation

目的研究远端缺血预处理(RIPC)对全胸腔镜下心脏瓣膜置换术患者Na^+-K^+-ATP酶和Ca^(2+)-Mg^(2+)-ATP酶的影响。方法将120例全胸腔镜下心脏手术患者分为全胸腔镜体外循环对照组(C组)和RIPC+全胸腔镜体外循环组(RIPC组)。观察RIPC组处理前后动脉血酸碱度的变化情况;检测比较不同时段心肌酶谱、肌钙蛋白I及氧化指标[超氧化物歧化酶(SOD)、丙二醛(MDA)];以及两组术前、术中以及术后Na^+-K^+-ATP酶和Ca^(2+)-Mg^(2+)-ATP酶的水平。结果与C组比较,RIPC后动脉血酸碱度较低(P<0.05);RIPC组肌酸激酶同工酶(CK-MB)和肌钙蛋白I在术后6h和24h低于C组(P<0.05);SOD活力高于C组而MDA水平低于C组(P<0.05);术后Na^+-K^+-ATP酶和Ca^(2+)-Mg^(2+)-ATP酶的水平也不同程度高于C组(P<0.05)。结论 RIPC可减轻全胸腔镜下心脏手术患者心肌损伤,这种保护作用可能与其激活相应ATP酶有关。

Objective To observe the effects of remote ischemic preconditioning（RIPC）on Na~＋-K~＋-ATP enzyme and Ca^（2＋）-Mg^（2＋）-ATP enzyme in thoracoscopic heart operation.Methods One hundred and twenty patients with thoracoscopic heart operation were randomly divided into the thoracoscopic extracorporeal circulation control group（C）and RIPC plus thoracoscopic extracorporeal circulation group（RIPC）.The acidity and alkalinity change of arterial blood before and after treatment was abserved in the RIPC group;the changes of myocardial enzymes spectrum,cTnI and oxidation indicators（SOD,MDA）were compared among different time periods,and preoperative and postoperative Na~＋-K~＋-ATP enzyme and Ca^（2＋）-Mg^（2＋）-ATP enzyme levels were also compared.Results Compared with the group C,the acidity and alkalinity of artery blood were lower after RIPC（P0.05）;the levels of CK-MB and cTnI at postoperative 6,24 hin the RIPC group were lower than those in those in the group C（P0.05）;the SOD activity was higher than that in the group C,while the MDA level was lower than that in the group C（P0.05）;the postoperative Na~＋-K~＋-ATP enzyme and Ca^（2＋）-Mg^（2＋）-ATP enzyme levels were higher than those in the group C at different degrees.Conclusion RIPC can alleviate myocardial injury in the patients with thoracoscopic heart operation and this effect may be related with activation of corres ponding ATP enzyme.