脂肪乳对体外循环心瓣膜置换术心肌的保护作用

目的 探讨体外循环下脂肪乳后处理对心瓣膜置换术患者心肌酶的影响。方法 将心瓣膜置换术患者40例随机分成2组,试验组20例,于主动脉开放即刻从体外循环机内快速注入200mL脂肪乳;对照组20例,同法注入200mL生理盐水。分别于主动脉阻断前及主动脉开放后0.5、1、2、4、24h采集桡动脉血,检测血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)浓度,同时行动脉血气分析,并记录两组患者血流动力学指标、体外循环时间、主动脉阻断时间、手术时间、心脏复跳情况、多巴胺使用量和术后辅助呼吸时间、重症监护室(ICU)停留时间、24h尿量和24h胸腔引流量。结果 两组患者血流动力学、多巴胺使用量、心脏自动复跳率、术后24h尿量及24h胸腔引流量比较差异无统计学意义(P>0.05);两组患者血清LDH、CK、CK-MB、cTnI水平均较主动脉阻断前升高(P<0.05);与对照组相比,试验组LDH在主动脉开放后24h时降低(P<0.05),cTnI和CK在主动脉开放后4、24h降低(P<0.05),CK-MB在主动脉开放后2、4、24h时间点降低(P<0.05)。结论 体外循环脂肪乳后处理可以降低心脏瓣膜置换术患者心肌酶的释放,减轻心肌缺血再灌注损伤。

Protective effect of intralipid on myocardium in extracorporeal circulation of cardiac valve replacement

Objective To investigate the effect of intralipid postconditioning on myocardial enzyme in patients receiving extracorporeal circulation of cardiac valve replacement. Methods Forty patients undergoing cardiac valve replacement were randomly divided into two groups. Patients in the experimental group were given intralipid (200 mL) immediately after aorta opening from the extracorporeal circulation machine, and those in the control group were given 200 mL normal saline in the same manner. The radial artery blood samples were collected at the beginning of the operation, 0.5 h, 1 h, 2 h, 4 h, and 24 h after aorta opening. The serum lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), and cardiac troponin I (cTnI) were observed and the blood gas analysis was performed. The hemodynamic parameters, time of cardiopulmonary bypass, time of aorta block, time of operation, recovery of heartbeat, the dosage of dopamine, assisted ventilation time, ICU detention time, 24 h urine amount, and 24 hour drainage amount after operation were all recorded in the two groups. Results There were no significant differences in hemodynamic parameters, dosage of dopamine used, spontaneous recovery of heartbeat, 24 h urine amount, or 24 hour drainage amount between the two groups (P>0.05). The postoperative levels of serum LDH, CK, CK-MB, and cTnI were significantly higher than those before operation in both groups (P<0.05).Compared with the control group, the LDH level in the experimental group was significantly deceased 24 h after aorta opening (P<0.05); cTnI and CK levels were significantly decreased 4 and 24 h after aorta opening (P<0.05); and CK-MB level were significantly decreased at 2, 4, and 24 h after aorta opening (P<0.05). Conclusion Intralipid postconditioning by cardiopulmonary bypass can reduce the release of myocardial enzymes in patients receiving heart valve replacement surgery, thus alleviate myocardial ischemia-reperfusion injury.