Effect of ulinastatin on the pathological links related to myocardial injury and ischemia reperfusion after cardiac surgery under cardiopulmonary bypass

Objective: To study the effect of ulinastatin on the pathological links related to myocardial injury and ischemia reperfusion after cardiac surgery under cardiopulmonary bypass. Methods: The patients undergoing valve replacement under cardiopulmonary bypass between February 2015 and December 2017 in Mianyang Central Hospital of Sichuan Province were chosen as the research subjects and randomly divided into the experimental group who accepted ulinastatin + creatine phosphate sodium intervention and the control group who accepted creatine phosphate sodium intervention. The levels of myocardial injury markers, apoptosis molecules, inflammation molecules and oxidative stress molecules in serum as well as the expression intensity of inflammation molecules and oxidative stress molecules in peripheral blood were determined before surgery and 24 h after surgery. Results: Serum cTnI, CK-MB, H-FABP, sFasL, sTWEAK, Caspase-3, Caspase-8, IL-1β, TNF-α, ICAM1, MDA and NO levels as well as peripheral blood TLR4, NLRP3, NOX2 and iNOS expression intensity of both groups of patients after surgery were significantly higher than those before surgery, and serum cTnI, CK-MB, H-FABP, sFasL, sTWEAK, Caspase-3, Caspase-8, IL-1β, TNF- , ICAM1, MDA and NO levels as well as peripheral blood TLR4, NLRP3, NOX2 and iNOS expression intensity of experimental group after surgery were significantly lower than those of control group. Conclusion: Ulinastatin can improve the apoptosis, inflammation and oxidative stress related to myocardial injury and ischemia reperfusion after cardiac surgery under cardiopulmonary bypass.

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

Objective:To study the effect of thyroid hormone (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. Observation group took euthyrox orally 1 week before surgery, control group took vitamin C tablets orally at the same point in time, and both therapies lasted for 1 week. Before taking medicine and after cardiopulmonary bypass (before end of surgery), serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were compared between the two groups of patients. Results: Before taking medicine, differences in the serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were not statistically significant between the two groups of patients. After cardiopulmonary bypass, serum myocardial enzyme spectrum indexes cTnT, CK-MB,α-HBD and LDH levels in observation group were lower than those in control group;serum nerve injury indexes NSE, S100B and GFAP levels were lower than those in control group while bFGF level was higher than that in control group.Conclusion: Euthyrox intervention in valve replacement under cardiopulmonary bypass can effectively reduce the myocardial and cerebral ischemia reperfusion injury.

CARDIOPULMONARY BYPASS WITH AUTOLOGOUS LUNG AS SUBSTITUTE FOR ARTIFICIAL OXYGENATOR ATTENUATES INFLAMMATORY RESPONSIVE INSPIRATORY DYSFUNCTION

Objective To study if using autologous lung as a substitute of oxygenator in cardiopulmonary bypass is better than the conventional cardiopulmonary bypass with artificial oxygenator in pulmonary preservation. Methods Twelve piglets were randomly divided into two groups (n=6). The isolated lung perfusion model was established. The experimental animals underwent continuous lung perfusion for about 120 min. While the control animals underwent 90 min lung ischemia followed by 30 min reperfusion. Another 12 piglets were randomly divided into two groups (n=6). The experimental animals underwent bi-ventricular bypass with autologous lung perfusion. While control animals underwent conventional cardiopulmonary bypass with artificial oxygenator. The bypass time and aortic cross clamping time were 135 min and 60 min respectively for each animal. The lung static compliance (Cstat), alveolus-artery oxygen difference (PA-aO_ 2 ), TNF-α, IL-6 and wet to dry lung weight ratio (W/D) were measured. Histological and ultra-structural changes of the lung were also observed after bypass. Results After either isolated lung perfusion or cardiopulmonary bypass, the Cstat decreased, the PA-aO_ 2 increased and the content of TNF-α increased for both groups, but the changes of experimental group were much less than those of control group. The lower W/D ratio and mild pathological changes in experimental group than those in control group were also demonstrated. Conclusion Autologous lung is able to tolerate the nonpulsatile perfusion. It can be used as a substitute to artificial ogygenator in cardiopulmonary bypass to minimize the inflammatory pulmonary injury caused mainly by ischemic reperfusion and interaction of the blood to the non-physiological surface of artificial oxygenator.

小白菊内酯调控NF-κB表达改善体外循环犬肺缺血再灌注损伤

目的研究小白菊内酯(PTL)对体外循环(CPB)犬肺缺血再灌注(IR)损伤的影响,并探讨其作用机制。方法18只健康成年中华田园犬,体重10~12 kg,采用随机数字表法分为假手术组(Sham)、肺缺血再灌注组(IR)和小白菊内酯组(PTL)。假手术(Sham)组不进行CPB,其余两组均建立CPB左肺缺血再灌注损伤模型。取CPB前(T_(1))、停机时(T_(2))和实验结束时(T 3)股动脉血行血气分析,计算呼吸指数(RI)和氧合指数(OI);ELSIA检测T_(1)、T_(2)和T_(3)时点血浆和T 3时点左肺肺泡灌洗液中IL-1β、IL-6和TNF-α含量;HE染色观察肺组织病理情况;qRT-PCR检测肺组织TNF-αmRNA表达水平;Western blot检测肺组织NF-κB p65、NF-κB p65和TNF-α蛋白表达水平。结果CPB后犬出现肺损伤,与IR组比较,T_(3)时点PTL组肺组织病理损伤减轻,RI明显降低(P<0.05),血浆、肺泡灌洗液中IL-1β、IL-6和TNF-α含量,肺组织TNF-αmRNA相对表达水平,TNF-α、NF-κB p65蛋白表达水平明显降低(P<0.05),OI明显升高(P<0.05)。结论PTL可改善CPB犬肺损伤,其机制可能与抑制NF-κB p65激活,减轻炎症反应有关。

乌司他丁在体外循环手术围手术期的保护作用研究进展

体外循环是进行心血管外科手术中的重要辅助手段,由此会导致机体各器官缺血再灌注损伤及炎症反应,增加术后并发症的发生率。乌司他丁作为一种广谱的胰蛋白酶抑制剂,其能抑制炎症介质释放,上调抗炎因子释放;抑制氧自由基生成与脂质过氧化反应,稳定溶酶体膜,减轻细胞与组织损伤,对于辅助治疗由体外循环手术引起的缺血再灌注损伤及全身炎症反应均有良好的治疗作用,并在围手术期对包括心脏、肝脏、肺脏、肾脏以及凝血、免疫等在内的多脏器多系统起保护作用。

不同剂量右美托咪定对成人体外循环心脏手术后血流动力学的影响研究

目的:探讨不同剂量右美托咪定对成人体外循环心脏手术后血流动力学的影响。方法:将2019年1月至2021年9月绵阳市中心医院收治的体外循环心脏手术后的成年患者共180例采用随机数字表法分为对照组、低剂量组和高剂量组(每组60例)。低剂量组患者给予右美托咪定0.4μg/(kg·h)泵入,高剂量组患者给予右美托咪定0.8μg/(kg·h)泵入,对照组患者给予等量0.9%氯化钠注射液泵入,其余处理方案三组一致。测量进入重症监护室(ICU)时(T_(0)),进入ICU后6 h(T_(1))、12 h(T_(2))和24 h(T_(3))的血流动力学指标和心肌酶学指标水平,记录心律失常发生率及最终点ICU停留时间。结果:低剂量组和高剂量组患者在T_(1)、T_(2)、T_(3)时的心输出量大于对照组,静脉血肌钙蛋白I、肌酸激酶同工酶及乳酸水平低于对照组,但未表现出明显剂量-效应关系。高剂量组患者较低剂量组和对照组更易出现缓慢型心律失常,但使用右美托咪定能缩短ICU停留时间。结论:使用右美托咪定可以稳定体外循环心脏手术后血流动力学,并对心肌缺血再灌注损伤起到一定的保护作用,缩短ICU停留时间,但无明显剂量-效应关系。使用高剂量的右美托咪定更易出现低血压及缓慢型心律失常。

右美托咪定在体外循环中的心肌保护作用研究进展

体外循环心脏直视手术是治疗心脏疾病的重要方法,主动脉钳夹作为手术重要手段,不可避免地引起心肌缺血及开放后的再灌注损伤。目前临床上采用多种措施以保护心肌,其中全身麻醉药物对心肌的保护作用也不容忽视。右美托咪定作为一种α2受体激动剂,具有减轻炎症反应、抑制细胞凋亡、减轻氧化应激、保护线粒体结构和功能等作用,在临床上被广泛使用。本文对右美托咪定在体外循环心脏手术中的心肌保护作用、机制和展望进行综述。

心脏停搏液的临床应用进展

良好的心肌保护是影响心脏手术成功的关键因素之一,而心脏停搏液是心肌保护的基石,在心肌保护中扮演着重要的角色。本文将对心脏停搏液的各要素比如停搏液设计、停搏液类型、灌注方式、停搏液温度等进行综述。

Ischemic postconditioning alleviates lung injury and maintains a better expression of aquaporin-1 during cardiopulmonary bypass

Background It has found that ischemic postconditioning （IPO） might decrease pulmonary ischemia/reperfusion （I/ R） injury,which is one of the main reasons of lung injury caused by cardiopulmonary bypass （CPB）.It was found that aquaporins （AQPs） play a role in the maintenance of fluid homeostasis.But it is still unclear whether IPO influences the expression of aquaporin-1 （AQP1）.This study was designed to investigate whether IPO can reduce CPB-related lung injury and affect the expression of AQP1 of lungs.Methods Twelve healthy dogs were divided into control group （C group） and ischemia postconditioning group （IPO group）.CPB procedures were implemented.Ten minutes later,the left pulmonary artery was separated and blocked.Postconditioning consisted of two cycles of 5-minute pulmonary artery reperfusion/5-minute reocclusion starting at the beginning of reperfusion.The 2×4 cm tissues of both sides of pulmonary apex,superior,middle and inferior lobe were taken before CPB （T1）,before occlusion and reopening of left pulmonary artery （T2,T3）,and 2 hours after CPB （T4）.Samples were used to evaluate lung injury degrees and to detect the expression of AQP1.At T1 and T4,blood was collected from femoral artery to calculate pulmonary function.Results At T4,each pulmonary function showed significant deterioration compared with T1.Lung injury could be found at the onset of CPB.However,the expression of AQP1 decreased and wet to dry weight ratio （W/D） increased after T2.In the left lung of C group,the worst pulmonary function and structures were detected.The slightest changes were discovered in the right lung of C group.A close relationship between W/D and lung injury score was found.The lung injury score was negatively related with the expression of AQP1.It was found that the expression of AQP1 was negatively connected with W/D.Conclusions In dog CPB models,lung injury induced by CPB was related with down regulated expression of AQP1.AQP1 is believed to be involved in the mechanisms of lung ischemia/reperfusion （I/R） injury caused by CPB.IPO increases the expression of AQP1,provides a protective effect on lung suffering from CPB,and alleviates CPB-related lung injury.

TBC1结构域家族成员4与心肌胰岛素抵抗的研究进展

体外循环是心血管外科开胸心内直视手术必需的重要辅助手段,而体外循环术后常见的严重并发症是心肌缺血再灌注损伤(MIRI)。MIRI的发生机制复杂,心肌胰岛素抵抗(IR)是其重要发病机制之一,其中心肌细胞葡萄糖转运蛋白4(GLUT4)的表达和转位异常是心肌IR发生的主要原因。TBC1结构域家族成员4是TBC家族蛋白的重要成员,可通过Rab蛋白调控GLUT4的囊泡转运,是磷脂酰肌醇-3-激酶/蛋白激酶B信号通路和AMP活化的蛋白激酶信号通路重要的下游靶点,与IR的发生密切相关。

右美托咪定对体外循环下心肌缺血再灌注损伤的保护效应

目的 观察右美托咪定（DEX）对体外循环下心肌缺血再灌注损伤的影响.方法 择期体外循环下行心脏二尖瓣置换术的患者60例,随机分为DEX组和对照组,各30例;DEX组恒速输注DEX 0.5 μg/（kg·h）,对照组恒速输注等量0.9%氯化钠.其余麻醉用药两组相同.两组患者分别于麻醉诱导前（T0）、主动脉开放后10 min（T1）、停机即刻（T2）、停机后4 h（T3）和术后24 h（T4）5个时点采集颈内静脉血各4 mL,测定血清一氧化氮（NO）、丙二醛（MDA）、超氧化物歧化酶（SOD） 以及心肌肌钙蛋白T（cTn-T）,肌酸激酶同工酶（CK-MB）的变化.结果 与T0时比较,两组T1～T4时血清NO及SOD活性均下降,血清MDA、cTn-T及CK-MB升高（P〈0.05）;两组之间比较,T2～T4时DEX组患者血清MDA、cTn-T和CK-MB低于对照组,SOD及NO高于对照组（P〈0.05）.结论 右美托咪定能在一定程度上减轻体外循环下的心肌缺血再灌注损伤,其机制可能与其抗氧化应激作用有关.

黄芪注射液配伍川芎嗪抗心肌缺血再灌注损伤的临床研究

目的：探讨黄芪注射液配伍川芎嗪防治体外循环心内直视手术中心肌缺血再灌注损伤（ＭＩＲＩ）的作用机理，并探讨ＭＩＲＩ的中医病机、治则。方法：风湿性心脏病瓣膜置换术和先天性心脏病室间隔修补术患者２４例，随机分为对照组、黄芪注射液组（益气组）川芎嗪组（活血组）、黄芪注射液配伍川芎嗪组（益气活血组）各６例。术中动态监测心电；分别在麻醉前（Ｔ１）、主动脉阻断１０ｍｉｎ（Ｔ２）、主动脉开放１０ｍｉｎ（Ｔ３）、３０ｍｉｎ（Ｔ４）、手术结束（约主动脉开放１８０ｍｉｎ，Ｔ５）经锁骨下中心静脉取血。测定血清谷草转氨酶（ＡＳＴ）、肌酸磷酸激酶（ＣＫ）、肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）、乳酸脱氢酶（ＬＤＨ）、丙二醛（ＭＤＡ）含量、超氧化物歧化酶（ＳＯＤ）活力、一氧化氮（ＮＯ）和一氧化氮合成酶（ＮＯＳ）活性。结果：治疗各组与对照组比较，可减轻心肌酶、ＭＤＡ和ＳＯＤ变化，益气活血组最明显，与对照组比较多数有显著性差异（Ｐ＜０．０５，Ｐ＜０．０１）。益气组（Ｔ５）和益气活血组（Ｔ４、Ｔ５）ＮＯ活力高于对照组（Ｐ＜０．０５）。结论：ＭＩＲＩ中医辨证，病位在心，证属气虚血瘀，其治则是益气活血。黄芪注射液配伍川芎嗪注射液对其有良好的保护作用，优?

七氟醚预处理和后处理对婴幼儿体外循环心肌再灌注损伤的影响

目的探讨七氟醚预处理、后处理和预处理复合后处理对婴幼儿先天性心脏病手术中体外循环心肌再灌注损伤的影响。方法选择60例室间隔缺损行心内直视手术的患儿,随机分为对照组(整个麻醉过程中不应用吸入麻醉药)、预处理组(主动脉阻断前吸入1.5 MAC的七氟醚20 min)、后处理组(主动脉开放后吸入1.5 MAC的七氟醚20 min)和预处理+后处理组(主动脉阻断前后分别吸入1.5 MAC的七氟醚20 min),每组15例。记录和比较各组主动脉阻断时间、体外循环时间、手术时间和入心脏重症监护病房(CICU)后的呼吸机支持时间、CICU滞留时间以及住院时间;分别于麻醉诱导后(T0)、体外循环开始前(T1)、体外循环结束即刻(T2)和体外循环后1 h(T3)、6 h(T4)、12 h(T5)、24 h(T6),测定心肌损伤标志物血浆心肌肌钙蛋白Ⅰ(cTnⅠ)、肌红蛋白(Mb)和肌酸激酶同工酶(CK-MB)的质量浓度。结果各组间主动脉阻断时间、体外循环时间、手术时间、入CICU后的呼吸机支持时间、CICU滞留时间及住院时间比较,差异均无统计学意义(P>0.05)。各组T2～T6时点的血浆cTnⅠ、Mb和CK-MB质量浓度均显著高于T0时点(P<0.05);预处理组、后处理组和预处理+后处理组T3～T5时点的血浆cTnI、Mb和CK-MB质量浓度均较相应时点的对照组显著降低(P<0.05);七氟醚各处理组间相应时点的血浆cTnI、Mb和CK-MB质量浓度比较差异无统计学意义(P>0.05)。结论七氟醚预处理和后处理均能减轻婴幼儿先天性心脏病手术中体外循环心肌再灌注损伤的程度,但两者合用并无明显的协同效应。

磷酸肌酸钠预先给药对2型糖尿病患者心肌缺血-再灌注损伤的影响

目的探讨磷酸肌酸钠预先给药对2型糖尿病心脏瓣膜置换术患者心肌缺血-再灌注损伤的影响。方法择期行二尖瓣置换术的2型糖尿病患者100例,年龄41～71岁,体重41～78kg,随机均分为两组：糖尿病对照组（NS组）和磷酸肌酸钠预先给药组（CP组）。CP组切皮时开始中心静脉输注磷酸肌酸钠10g（溶于100m性理盐水）,输注时间60min,NS组静脉输注等容量生理盐水,分别于麻醉前、术后第1天和第3天采集颈内静脉血样,检测血清磷酸肌酸激酶（CK）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）,测定心肌肌钙蛋白I浓度（cTnI）,观察自动复跳情况,记录术后3d内使用血管活性药物情况和心血管不良事件发生情况。结果与麻醉前比较,术后第1天两组患者血清CK、LDH、CK-MB、cTnI浓度均明显升高（P〈0.05）;术后第3天NS组CK、LDH、CK-MB、cTnI浓度明显升高（P〈0.05）。与NS组比较,CP组术后第1天和第3天血清CK、LDH、CK-MB、cTnI浓度明显降低（P〈0.05）,术后3d内使用正性肌力药物的例数和术后心血管事件发生例数明显减少（P〈0.05）,术中心脏自动复跳例数明显增多（P〈0.05）。结论磷酸肌酸钠预先给药可减轻2型糖尿病患者心肌缺血-再灌注损伤,改善预后。

山莨菪碱心肌保护作用的临床研究

目的 :观察山莨菪碱 ( 654 2 )对体外循环 ( CPB)心肌缺血再灌注损伤的保护作用。方法 :将 2 4例心脏瓣膜置换术患者随机分为 654 2组 ( 1 3例 )和对照组 ( 1 1例 ) ,654 2组患者术中心肌灌注液中加入 654 2( 1 5mg/50 0 ml) ,对照组则常规用冷晶体停搏液。通过右心房插管分别于手术开始前、转流后 3 0分钟、主动脉开放后、停机、手术结束、术后 1日及术后 3日抽血测定血中超氧化物歧化酶 ( SOD)和丙二醛 ( MDA)的含量 ,并观察 2组患者术中心脏复跳情况和术后正性肌力药物的使用情况。结果 :2组术中血 SOD均明显下降 ,以对照组更为显著 ( P<0 .0 5) ,术后 1日 654 2组血 SOD含量接近术前水平 ,而对照组于术后 3日才恢复术前水平。 2组术中血 MDA含量则较术前上升 ,仍以对照组为明显 ( P<0 .0 5) ,手术结束时开始下降 ,术后 3日降至术前水平。术中主动脉开放后 654 2组心脏自动复跳率较对照组高 ,术后对照组正性肌力药物 (多巴胺等 )的使用量较 654 2组增多。结论 :654 2可保护缺血再灌注损伤心肌细胞 SOD活性 ,减少心肌细胞 MDA产生 ,有效地保护心肌功能。

右美托咪定对全麻低温心肺转流下冠状动脉旁路移植术围术期的心肌保护作用

目的观察右美托咪定对全麻低温心肺转流（CPB）下冠状动脉旁路移植术患者围术期的心肌保护作用。方法择期行全麻低温CPB下冠状动脉旁路移植术患者80例,男67例,女13例。随机均分为右美托咪定组（A组）和对照组（C组）。在中心静脉置管后,A组静脉泵注右美托咪定4μg·kg^-1·h^-1持续15min后调节维持剂量0.7μg·kg^-1·h^-1直到手术结束,C组用同样方案静注等容量生理盐水。记录入室后（T0）、麻醉诱导后（T1）、切皮时（T2）、CPB终止时（T3）和手术结束时（T4）的HR、SBP、DBP和血管活性药物用量。测定T1～T4、术后6h（T5）和术后24h（T6）血浆肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）、肾上腺素（E）和去甲肾上腺素（NE）浓度。结果与T0时比较,T1时两组HR明显减慢,SBP和DBP明显降低（P〈0.05）。与T1、T2时比较,T3～T6时两组CK-MB、cTnT、E浓度明显升高（P〈0.05）,T3～T5时A组NE浓度明显下降（P〈0.05）,T6时明显升高（P〈0.05）。T3～T6时A组CK-MB和cTnT浓度明显低于C组（P〈0.05）。T3～T5时A组E和NE浓度明显低于C组（P〈0.05）。两组在围术期均未出现严重不良反应。结论右美托咪定能降低全麻低温CPB下冠状动脉旁路移植术围术期心肌缺血的发生,达到围术期心肌保护的作用。

缺血预处理对缺血再灌注心肌细胞凋亡的影响

目的 :观察缺血预处理 (ischemicpreconditioning ,IPC)对体外循环中缺血再灌注心肌细胞凋亡的影响 ,评价其对心肌的保护作用。 方法 :在猫体外循环 (cardiopulmonarybypass,CPB)模型的基础上随机分成 3组 :组 1(单纯CPB组 ,n =18)和组 2 (主动脉阻断组 ,n =18)于CPB开始 4 5min后阻断主动脉 ,6 0min后开放主动脉使心脏恢复再灌注 90min ;组 3(IPC组 ,n =18)于主动脉阻断前进行IPC(阻断升主动脉 5min后开放 10min ,并重复 3次 ) ,余处理与组 2相同。应用Annexin Ⅴ /PI联合染色、流式细胞仪检测心肌细胞膜磷脂酰丝氨酸的外翻 ,比较IPC处理组及单纯缺血再灌注组体外循环过程中 4 5、10 5、195min时间点心肌细胞坏死和凋亡的数量。 结果 :组 2于主动脉阻断 6 0min及再灌注 90min时心肌细胞坏死率分别为(2 .6 75± 0 .4 2 4 ) %及 (5 .32 7± 0 .5 13) % ,而组 3则分别为 (1.317± 0 .2 92 ) %和 (3.112± 0 .32 8) % ,两组主动脉阻断 6 0min时 ,均未检出凋亡心肌细胞 ,但在再灌注 90min时 ,组 2和组 3的心肌细胞凋亡率分别达 (2 .32 7± 0 .6 73) %和 (0 .94 3± 0 .14 6 ) %(P <0 .0 1)。IPC处理组缺血再灌注期间坏死及凋亡的心肌细胞明显减少。 结论 :IPC不仅能减少体外循环缺血再灌注导致的心肌细胞坏?

参附注射液对心肌缺血再灌注损伤保护作用的临床研究

目的 探讨参附注射液在体外循环 (CPB)心内直视手术中的心肌保护作用。方法 6 0例接受心内直视手术患者随机分为对照组和观察组。对照组在全麻低温体外循环下行心内直视手术 ,围术期对症支持处理 ;观察组在对照组方法的基础上加用参附注射液 ,方法为术前 5d静滴参附注射液 2ml/ (kg·d) ,术中建立CPB后滴入 2ml/kg ,并予维持至升主动脉开放后 10min。于升主动脉阻断前 ,开放后 5 ,10min从冠状静脉窦取血 2ml,测定超氧化物歧化酶 (SOD)、丙二醛 (MDA)含量 ;升主动脉阻断前 ,停CPB后 4 ,2 4 ,4 8h从中心静脉取血 2ml测定肌酸激酶同工酶 (CK-MB)及心肌肌钙蛋白I(cTn -I)水平。结果 观察组SOD含量高于对照组 ,而MDA、CK -MB、cTnI均低于对照组 (P <0 .0 5或P <0 .0 1)。结论 围术期参附注射液在心内直视手术中可减轻心肌缺血再灌注损伤 。

猫体外循环时心肌caspase3 mRNA表达的变化

目的 :观察猫体外循环 (CPB)时心肌 caspase3m RNA表达的变化。方法 :根据人和鼠 caspase3m RNA基因序列 ,利用 DNASIS软件设计猫 caspase3基因的 PCR引物 ,采用 RT- PCR检测 CPB过程中心肌 caspase3m RNA的表达。结果 :CPB主动脉阻断 (ACC)过程中猫心肌 caspase3m RNA的表达与 ACC前相比未见明显增高 ,再灌注 1 5 min时心肌 caspase3m RNA的表达量较 ACC前明显增加 (P<0 .0 1 ) ,再灌注 90 m in时心肌 caspase3m RNA的表达量为 ACC前的 4倍 ,差异有显著性意义 (P<0 .0 1 )。结论 :CPB中的缺血再灌注损伤可导致心肌 caspase 3基因表达增加 ,而再灌注过程可能是 caspase

乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关病理环节的影响

目的:研究乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关病理环节的影响。方法:选择在四川省绵阳市中心医院进行体外循环下瓣膜置换术的患者作为研究对象,随机分为接受乌司他丁+磷酸肌酸钠干预的实验组、接受磷酸肌酸钠干预的对照组。手术前及手术后24小时,测定血清中心肌损伤标志物、凋亡分子、炎症分子、氧化应激分子的含量及外周血中炎症分子、氧化应激分子的表达强度。结果:两组手术后血清中cTnI、CK-MB、H-FABP、sFasL、sTWEAK、Caspase-3、Caspase-8、IL-1β、TNF-α、ICAM1、MDA、NO的含量及外周血中TLR4、NLRP3、NOX2、iNOS的表达强度均较手术前显著升高且实验组患者手术后血清中cTnI、CK-MB、H-FABP、sFasL、sTWEAK、Caspase-3、Caspase-8、IL-1β、TNF-α、ICAM1、MDA、NO的含量及外周血中TLR4、NLRP3、NOX2、iNOS的表达强度均显著低于对照组。结论:乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关的细胞凋亡、炎症反应、氧化应激反应均具有改善作用。