改善非体外循环冠状动脉旁路移植术患者左心功能的局部缺血预适应

目的:通过测定非体外循环冠状动脉旁路移植术围术期左心功能的变化研究局部缺血预适应(rIP)的心肌保护作用。方法:将36例患者随机分成2组:rIP组(19例),在首支冠状动脉吻合前采用2轮左冠状动脉前降支rIP:首次为2min缺血3min再灌注,第2次为5min缺血5min再灌注;对照组(17例)在首支冠状动脉吻合前不进行rIP。对2组的左心功能进行对比研究。结果:rIP组心率增加低于对照组(P<0·01)。术后第1天rIP组心脏指数、每搏量指数以及左室作功指数均好于对照组(2.6±0.1)∶(2.5±0.1),P<0·01;(38.1±5.0)∶(35.0±3.1),P<0·05;(2.8±0.2)∶(2.6±0.2),P<0·05)。平均动脉压、肺毛细血管压、和体循环阻力2组之间差异无统计学意义。结论:首轮为2min缺血3min再灌注;第2轮为5min缺血5min再灌注可以安全地用于非体外循环冠状动脉旁路移植术,可以保护心肌避免不可逆性损伤。

Regional ischemic preconditioning enhances myocardial performance in off-pump coronary operation

Objective:To investigate whether left ventricular function could benefits from regional ischemic preconditioning (rIP) by reduce myocardial injury in patients undergoing elective off-pump coronary artery bypass grafting. Method:Nineteen patients with preceding rIP were compared with 17 patients without it. The rIP group underwent two additional myocardial regional ischemia of left anterior descending coronary artery (LAD) at the beginning of revascularization operation, before the ischemic period used for the first coronary artery bypass graft distal anastomosis: that were a 2-minute period of ischemic followed by a 3-minute reperfusion period, then a 5-minute period of ischemia followed by a 5-minute reperfusion period. Result:Registration included hemodynamic data from the peripheral artery and the pulmonary artery. rIP resulted in a complete recovery of the cardiac index, the mean stroke volume index and left ventricular stroke work index after the operation. At sixth hour and on the first postoperative day after the operation, the increase in the mean heart rate was also significantly lower in the rIP group. The mean artery pressure, the pulmonary capillary wedge pressure and the systemic vascular resistance did not reach statistic significant between the groups. Conclusion: The two cycles of regional 2 min rIP followed by 3 min reperfusion, then 5 min rIP followed 5 min reperfusion in the LAD proved to be applicable and safe in patients undergoing off-pump myocardial revascularization, it protect patients against irreversible myocyte injury as manifest by tended to improve left ventricular function and prohibited the postoperative increase in heart rate.