普伐他丁预处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of preoperative pravastatin preconditioning on myocardial ischemia-repedusion(I／R)injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ orⅢpatients of both sexes aged 18-64 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups(n=15 each)：control group(group C)and 3 pravastatin groups receiving oral pravastatin 10，20 and 40 mg respectively every night for 7 days before operation(group P1-3).The number of patients receiving dopamine(≥5 μg·kg-1·min-1)and adrenaline was recorded from the termination of CPB to the end of operation，from the end of operation to 12 h after operation，during 12-24 h after operation and during 24-48 h after operation.Venous blood samples were taken from central venous line for measurement of plasme cTnI and CK-MB concentrations at 7 days before operation，before induction of anesthesia，at opening of the aorta and at 2，24 and 48 h after opening of aorta.Results The number of patients receiving dopamine and adrenaline was significantly less in group P3 than in group C(P<0.05).Plasma CK-MB and cTnI concentrations were significantly lower in group P3 than in group C(P<0.05).Conclusion Preconditioning with oral pravastatin(40mg／d for 7 consecutive days)can protect myocardium against I／R injury in patients undergoing cardiac valve replacement with CPB.     

普伐他丁预处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of preoperative pravastatin preconditioning on myocardial ischemia-repedusion(I／R)injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ orⅢpatients of both sexes aged 18-64 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups(n=15 each)：control group(group C)and 3 pravastatin groups receiving oral pravastatin 10，20 and 40 mg respectively every night for 7 days before operation(group P1-3).The number of patients receiving dopamine(≥5 μg·kg-1·min-1)and adrenaline was recorded from the termination of CPB to the end of operation，from the end of operation to 12 h after operation，during 12-24 h after operation and during 24-48 h after operation.Venous blood samples were taken from central venous line for measurement of plasme cTnI and CK-MB concentrations at 7 days before operation，before induction of anesthesia，at opening of the aorta and at 2，24 and 48 h after opening of aorta.Results The number of patients receiving dopamine and adrenaline was significantly less in group P3 than in group C(P<0.05).Plasma CK-MB and cTnI concentrations were significantly lower in group P3 than in group C(P<0.05).Conclusion Preconditioning with oral pravastatin(40mg／d for 7 consecutive days)can protect myocardium against I／R injury in patients undergoing cardiac valve replacement with CPB.     

大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of high-dose creatine phosphate (CP) on myocardial ischemia-reperfusion (I/R) injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups: control group ( n = 122) and CP group ( n = 124). CP 10 g in 100 ml normal saline (NS) was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia (auricular fibrillation, ventricular arrhythmia), myocardial infarct and left ventricular ejection fraction (LVEF) were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.     

大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of high-dose creatine phosphate (CP) on myocardial ischemia-reperfusion (I/R) injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups: control group ( n = 122) and CP group ( n = 124). CP 10 g in 100 ml normal saline (NS) was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia (auricular fibrillation, ventricular arrhythmia), myocardial infarct and left ventricular ejection fraction (LVEF) were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

目的 探讨大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法 择期拟行二尖瓣-主动脉瓣置换术患者246例,年龄42～71岁,体重45～80 kg,随机分为2组:对照组(NS组,n=122)和磷酸肌酸钠预先给药组(CP组,n=124).CP组切皮时开始中心静脉输注磷酸肌酸钠10g(溶于100ml生理盐水),输注时间60 min,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5天采集颈内静脉血样,检测血清磷酸肌酸激酶、乳酸脱氢酶、肌酸激酶同工酶的活性,测定心肌肌钙蛋白I浓度,观察心律失常、心肌梗塞的发生情况及自动复跳情况,记录使用正性肌力药多巴胺(≥5 μg·kg-1·min-1)和肾上腺素的患者例数及左室射血分数.结果 与NS组比较,CP组术后第1天和第5天血清磷酸肌酸激酶、乳酸脱氢酶、肌酸激酶同工酶的活性及心肌肌钙蛋白I浓度降低,使用多巴胺和肾上腺素的患者例数减少,术后心律失常和心肌梗塞的发生率降低,自动复跳率及左室射血分数升高(P<0.05).结论 大剂量磷酸肌酸钠(10 g)预先给药可减轻二尖瓣-主动脉瓣置换术患者的心肌缺血再灌注损伤,改善心脏功能.     

远程缺血预处理对心肺转流心脏瓣膜置换术患者心肌损伤的保护作用

目的探讨远程缺血预处理(RIPC)对心肺转流(CPB)下心脏瓣膜置换术患者心肌损伤的影响。方法 CPB心脏瓣膜置换术患者40例,随机均分为研究组(E组)和对照组(C组)。E组于麻醉诱导插管完毕稳定5min后,应用骨科气压止血带给左上肢加压至35kPa,5min后,减压至0kPa,5min后重复加压,共4次,而C组只固定止血带,不加压。分别于麻醉诱导插管完毕稳定5min后(T1)、主动脉开放30min后(T2)、CPB停止后2h(T3)、术后12h(T4)、术后24h(T5)测颈内静脉血心肌肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)浓度。结果与T1相比,两组cTnI浓度在T2时升高达峰值,随后持续下降;两组CK-MB浓度在T2时开始升高,T3时升高达峰值,随后持续下降。E组cTnI、CK-MB浓度在T2～T5时均明显低于C组(P<0.05或P<0.01)。结论 RIPC可降低CPB下心脏瓣膜置换术患者围术期cTnI、CK-MB的释放,减少围术期血管活性药物用量,减轻心肌的缺血-再灌注损伤,具有一定的心肌保护作用。     

参脉注射液对心脏瓣膜置换术的心肌保护作用

目的探讨参脉注射液(SMI)在心脏瓣膜置换术中对心肌缺血-再灌注损伤的保护作用。方法将40例心脏瓣膜置换术患者随机均分为参脉组(SM组)和对照组(C组),SM组在心肺转流(CPB)前静脉给予SMI,C组用等量生理盐水。分别于术前、术中、术后多时点采血,比较两组心肌磷酸激酶(CK)、磷酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;记录两组患者的手术时间、主动脉阻断时间及术中、术后各时点血管活性药物的用量,观察主动脉开放后心脏自动复跳率、室性心律失常发生率。结果SM组血清CK、CK-MB、cTnI、MDA等指标均低于C组(P<0.05),而两组SOD活性均降低,但SM组明显高于C组(P<0.05)。SM组室性心律失常发生率、除颤次数及血管活性药物的用量明显低于C组(P<0.01)。结论SMI对心脏瓣膜置换术患者心肌缺血-再灌注损伤具有明显保护作用。     

参附注射液预先给药对体外循环下瓣膜置换术患者心肌的保护作用

目的 探讨参附注射液预先给药对体外循环下瓣膜置换术患者心肌的保护作用.方法 择期体外循环下拟行瓣膜置换术的患者30例,年龄18～51岁,体重45～73kg,ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机分为2组(n=15),对照组(C组)和参附注射液预先给药组(SH组).SH组于术前5 d静脉输注参附注射液1.5 ml/kg,1次/d,连续5 d,麻醉诱导前30 min再次静脉输注参附注射液1.5 ml/kg,参附注射液均溶于5%葡萄糖溶液或生理盐水250 ml中;C组不输注参附注射液,余治疗同SH组.于主动脉阻断前即刻(T_1)、主动脉开放后10 min(T_2)、30 min(T_3)、2 h(T_4)、24 h(T_5)、48 h(T_6)时取右侧颈内静脉血样2 ml,采用免疫抑制法测定血浆肌酸激酶同工酶(CK-MB)及乳酸脱氢酶(LDH)的活性;于T_(1～3)时取冠状静脉窦血样2 ml,分别测定血浆丙二醛(MDA)、心肌肌钙蛋白I(cTnI)的浓度及超氧化物歧化酶(SOD)活性;于主动脉阻断前即刻及开放后即刻取右心房全层心肌组织,电镜下观察心肌细胞线粒体超微结构.记录心脏自动复跳情况、血管活性药物使用情况及主动脉阻断时间.结果 与T_1时比较,两组T_(2,3)时血浆cTnI和MDA浓度升高,T_(2～6)时CK-MB及LDH活性升高,T_(2,3)时SOD活性降低(P<0.05或0.01);与C组比较,SH组T_(2,3)时血浆cTnI和MDA浓度降低,T_(2～6)时CK-MB和LDH活性降低,多巴胺和硝酸甘油用量明显减少,T_(2,3)时血浆SOD活性及心脏自动复跳率明显升高(P<0.05或0.01).SH组心肌细胞线粒体病理损伤程度较C组明显减轻.结论 体外循环下瓣膜置换术患者参附注射液预先给药可产生一定程度的心肌保护作用,其机制可能与抑制脂质过氧化反应有关.     

缺血预处理对心肌的保护作用

目的 探讨定量检测血清心肌肌钙蛋白I(cTnI)，并结合临床指标，评价心肌缺血预处理(IPC)对缺血心肌的保护作用。方法 将40例择期心瓣膜置换术患者随机分为IPC组和对照组，每组20例。IPC组采用2个周期的3分钟缺血 5分钟再灌注方案。两组分别于体外循环(CPB)前、CPB后、术后l0小时、24小时、72小时和6天测定血清cTnI，比较两组间cTnI、术毕心脏自动复跳率、术后室性心律失常发生率、正性肌力药物使用率和死亡率。结果 术后两组cTnI均立即升高，对照组在术后l0小时达峰值，而IPC组在CPB后即达峰值；CPB前和术后6天两组cTnI比较差别无显著性意义(P＞0．05)，其余各时点对照组cTnI值均明显高于IPC组(P＜0．05)；对照组术后室性心律失常发生率和正性肌力药物使用率均明显高于IPC组(P＜0．05)。结论 IPC能降低缺血心肌血清cTnI浓度，降低患者术后室性心律失常发生率，减少术后正性肌力药物的使用率，对缺血心肌具有保护作用。     

米力农对心肺转流心瓣膜置换术患者心肌缺血-再灌注损伤的影响

目的比较心肺转流(CPB)下心瓣膜置换术使用米力农和硝酸甘油时患者血浆中心肌肌钙蛋白I(cTnI)及肌酸激酶同功酶MB(CK-MB)水平的变化,了解其对心肌缺血-再灌注损伤的影响.方法择期心内直视手术心瓣膜置换患者24例,分为米力农组(M组)和硝酸甘油组(N组),每组12例.分别于全麻诱导前(T0)、主动脉开放后10min(T1)和术毕(T2)抽取患者中心静脉血,测定cTnI和CK-MB血浆水平.结果M组cTnI在T1和T2均较N组低(P＜0.05).两组CK-MB组间比较M组略低于N组(P＞0.05).M组和N组内cTnI、CK-MB在T1和T2所测定值均高于T0(P＜0.05),且T2高于T1(P＜0.05).两组cTnI、CK-MB随时间推移呈明显上升趋势.结论CPB下行心瓣膜置换术时使用米力农比使用硝酸甘油更有可能改善心肌的缺血-再灌注损伤.     

体外循环旁路洗入七氟醚对冠状动脉旁路移植术患者心肌损伤的影响

目的 评价体外循环(CPB)旁路洗入七氟醚对冠状动脉旁路移植术(CABG)患者心肌损伤的影响.方法 择期CPB下行CABG的患者40例,年龄50 ～ 64岁,体重53～90 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组(n=20):对照组(C组)和七氟醚组(S组).S组于CPB开始即刻通过体外循环机洗入1.0％ ～2.0％七氟醚,持续到CPB结束,C组不给予七氟醚.于麻醉诱导后5 min(T0)、术后6 h(T1)、12 h(T2)及24 h(T3)时采集血样,测定血浆心肌肌钙蛋白I(cTnI)浓度和磷酸肌酸激酶同工酶(CK-MB)活性.于主动脉阻断前和CPB结束时取右心耳组织,电镜下观察心肌超微结构,并行心肌细胞线粒体损伤评分.结果 与C组比较,S组T2和T3时血浆cTnI浓度,CPB结束时心肌细胞线粒体损伤评分降低(P＜0.05),血浆CK-MB活性差异无统计学意义(P＞0.05).S组心肌病理学损伤较C组减轻.结论 CPB旁路洗入七氟醚可减轻CABG术患者的心肌损伤.     

地氟烷在二尖瓣置换手术中对缺血再灌注心肌的保护作用

在心脏外科手术中心肌缺血再灌注(ischemia-reperfusion,I-R)损伤的防治是急需解决的问题。缺血预处理(ischemic preconditioning,IPC)具有心肌保护作用[1,2]。研究显示挥发性麻醉药也具有类似IPC的麻醉药预处理(anesthetic-induced preconditioning,APC)作用[3,4],能减轻I-R后     

右美托咪定预处理对心脏瓣膜置换术患者心肌肌钙蛋白Ⅰ和心肌酶学的影响

【摘要】〓目的〓观察右美托咪定预处理对脏瓣膜置换术患者心肌肌钙蛋白Ⅰ和心肌酶学的影响,探讨其对缺血再灌注损伤心肌的保护作用。方法〓拟择期行瓣膜置换术患者50例随机分为右美托咪定组(D组,n=25)和对照组(C组,n=25)。D组在麻醉诱导前经15 min静脉泵注右美托咪定0.5 μg/kg,随后以0.5 μg·kg^-1·h^-1速率泵注至阻断主动脉。C组泵注等容量生理盐水。所有患者手术前(T₀),主动脉阻断30 min(T₁)、主动脉开放1 h(T₂),术毕(T₃)和术后24小时(T₄)抽血测定磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)的活性及心肌肌钙蛋白I(cTnI)的浓度。观察自动复跳率、心律失常发生率、左室射血分数(LVEF)以及血管活性药物使用情况。结果〓与C组相比,D组的cTnI浓度、CK和CK-MB的活性、多巴胺和肾上腺素用量低于C组;两组自动复跳率和心律失常发生率无统计学差异;D组术后LVEF值高于C组。结论〓右美托咪定预处理可减轻瓣膜置换患者的心肌损伤。     

乌司他丁后处理及其联合预先给药对CPB下心脏瓣膜置换术患者心肌炎性反应的影响

目的 评价乌司他丁后处理及其联合预先给药对CPB下心脏瓣膜置换术患者心肌炎性反应的影响.方法 择期行CPB下心脏瓣膜置换术患者80例,性别不限,年龄21～59岁,心功能分级Ⅱ或Ⅲ级.采用随机数字表法,将患者随机分为4组(n=20):生理盐水对照组(C组)、乌司他丁预先给药组(U1组)、乌司他丁后处理组(U2组)和乌司他丁预先给药联合后处理组(U3组).U1组于气管插管后至升主动脉阻断前10 min经中心静脉输注乌司他丁500～ 1000 U·kg-1·min-(剂量20 000U/kg);U2组于主动脉开放前5～7 min经主动脉根部灌注乌司他丁4000～5000 U·kg-1·min-1(剂量10 000 U/kg);U3组进行乌司他丁预先给药联合后处理;C组给予等容量生理盐水.分别于升主动脉阻断前10 min(T1)、升主动脉阻断后40 min(T2)、主动脉开放后45 min(T3)和术毕(T4)时采集动脉血样,测定血浆IL- 10、IL-1、IL-6和TNF-α的浓度,并进行中性粒细胞(PMN)计数.于主动脉开放后45min时取右心耳组织,采用免疫组化法测定IL-6和IL-1β的表达.结果 与C组比较,U1组、U2组和U3组血浆IL-10浓度升高,血浆IL-1、IL-6、TNF-α的浓度和PMN计数降低,心肌组织IL-1β和IL-6表达下调(P＜ 0.05);与U1组和U2组比较,U3组T2-4时血浆IL-10浓度升高,血浆IL-1、IL-6、TNF-α的浓度和PMN计数降低,心肌组织IL-1β和IL-6表达下调(P＜0.05).结论 乌司他丁后处理可抑制CPB下心脏瓣膜置换术患者心肌炎性反应,联合预先给药时其效应增强.