逆行灌注对心脏瓣膜置换术患者血清可溶性细胞间黏附分子-1、可溶性P-选择素和心肌肌钙蛋白Ⅰ的影响

目的 探讨风湿性心脏病行心脏瓣膜置换术患者,经冠状静脉窦逆行灌注对血清可溶性细胞间黏附分子(sICAM)-1、可溶性P-选择素(sPs)和心肌肌钙蛋白Ⅰ(cTnI)的影响.方法 将56例风湿性心脏病行体外循环(CPB)下心脏瓣膜置换术患者随机分为两组:主动脉根部顺行灌注心肌停跳液(AC)组和持续经冠状静脉窦逆行灌注心肌停跳液(RC)组,每组28例.于6个时点采静脉血,检测sICAM-1、sPs和cTnI水平.结果 CPB开始后,两组患者sICAM-1、sPs和cTnI水平均升高,术后8 h达到峰值,但RC组峰值均低于AC组[sICAM-1为(817.9±133.2)μg/L比(901.1±132.0)μg/L,sPs为(83.46±16.24)μg/L比(107.82±19.68)μg,L,cTnI为(10.50±2.03)μg/L比(14.45±2.26)μg/L],且RC组回落速度快于AC组.结论 逆行灌注能有效抑制sICAM-1、sPs和cTnI的表达,减轻炎性反应,从而起到更好的心肌保护作用.

Effects of retroperfusion on the levels of serum soluble inetr cellular adhesion molecule-1,soluble P-selectin and cardiac troponin Ⅰin patients of cardiac operation under direct vision

Objective To investigate the effects of retrograde cardioplegia on serum soluble inter cellular adhesion molecule (sICAM)-1,soluble P-selectin (sPs) and cardiac troponin Ⅰ(cTnI) in the process of heart valve replacement operation.Methods Fifty-six cases undergoing heart valve replacement with cardiopulmonary bypass (CPB) were divided into antegrade cardioplegia (AC) group and retrograde cardioplegia (RC) group.Serum levels of sICAM-1,sPs and cTnI were measured using enzyme-linked immunosorbent assayd (ELISA) at six times.Results After the CPB,the levels of sICAM-1,sPs and cTnI ascended quickly,at the time of 8-hour after operation achieved the peak value.The peak value of RC group were lower than those of AC group[sICAM-1 (817.9±133.2)μg/L vs(901.1±132.0)μg/L,sPs(83.46±16.24)μg/L vs(107.82±19.68) μg/L,cTnI(10.50±2.03) μg/L vs (14.45±2.26)μg/L],and the dedined degree of RC group were faster than those of AC group.Conclusion Retroperfusion has a better myocardial protection to the patients suffering heart valve replacement operation through active suppressed expression of sICAM-1,sPs and cTnI palliated inflammatory reaction.