心脏跳动中二尖瓣置换术心肌组织黏附分子的变化

目的观察心脏跳动中二尖瓣置换术围术期心肌细胞间黏附分子-1（ICAM-1）和血管细胞间黏附分子-1（VCAM-1）的表达。方法30例风湿性二尖瓣病变病人分为两组，试验组（浅低温下阻断主动脉）16例与对照组（中度低温阻断主动脉）14例。分别于CPB前、CPB后30min留取右心房标本，采用免疫组织化学技术检测心肌细胞上ICAM-1和VCAM-1的表达。结果与CPB前比较较，两组CPB后心肌细胞上ICAM-1和VCAM．1的表达明显升高（P〈0．01）。与对照组相比，试验组CPB后ICAM-1和VCAM-1的表达明显降低（P〈0．01）。结论心脏跳动中二尖瓣置换术对心肌细胞上黏附分子的影响较停跳手术少，减轻了术后的炎症反应。

The changes of adhesion molecule on myocardium during mitral valve replacement operation on beating heart

Objective Investigate the changes of adhesion molecule on myocardium in patients during mitral valve replacement(MVR) operation on beating heart. Methods Patients were divided into two groups. There were 16 patients in control group (aorta crossclamped and middle hypothermic) and 14 patients in experimental group (aorta unclamped and moderate hypothermic). Samples of right atrial were obtained before CPB, 30 min after CPB. Immunohistochemistry were employed to dectect the expression of ICAM-1 and VCAM-1 on cardiac myocytes. Results Comparing with those before CPB, ICAM-1 and VCAM-1 on cardiac myocytes and myocardial vascular endothelial cells increase significantly in both groups(P<0.01); ICAM-1 and VCAM-1 were significantly lower in experimental group than those in control group at 30 min after CPB(P<0.01). Conclusion The effect of MVR operation in beating heart on the myocardial adhesion molecule was less than those in stop heart operation and the inflammation response may be decreased after operation.