远隔缺血时处理减轻心脏瓣膜置换术后的肝损伤

【目的】观察远隔缺血时处理（remote ischemic preconditioning ，RIPer）对心脏瓣膜置换术患者的肝保护作用。【方法】40例择期体外循环下行瓣膜置换术的患者，随机分为两组：远隔缺血时处理组（RIPer组）和对照组（C组），每组20例。麻醉诱导前，将止血带绑于患者左下肢，RIPer组在主动脉阻断即刻，对患者左下肢实施缺血5 min/再灌注5 min处理，重复3个循环。C组不做缺血处理。于麻醉诱导前（d0），术后d1，d3及d7各时间点取颈内静脉血5 mL ，检测血清丙氨酸转氨酶（ALT）、谷氨酸转氨酶（AST ）、总胆红素（TBIL ）、总胆汁酸（TBA）、RIPer处理前和处理后24 h超氧化物歧化酶（Superoxide Dismutase ，SOD）的浓度。【结果】手术后两组患者的血清ALT及AST浓度均不同程度升高，RIPer组ALT水平在术后d1，d3，d7低于C组（ P＜0．05），AST水平在d1，d3低于C组（ P ＜0．05），而在d7则没有显著性差异（ P＞0．05）；两组TBIL、TBA水平在术后d1，d3， d7不具有显著性差异。远隔缺血时处理24 h后血浆SOD活力明显高于对照组。【结论】远隔缺血时处理可减轻体外循环后的急性肝损伤，但对肝脏的储备功能影响不大；这种保护作用可能与SOD有关。

Remote Ischemic Preconditioning to Reduce Liver Injury after Valve Replacement Surgery

Objective] To observe the effect of remote ischemic preconditioning （RIPer） for protecting the liver of patients undergoing valve replacement surgery .Methods] Totally 40 patients scheduled for selective valve re-placement surgery under cardiopulmonary bypass were randomly divided into remote ischemic preconditioning is-chemic group（RIPer group ,n =20） and control group（group C ,n = 20） .Before anesthesia ,cuff-inflator was placed on lower left limb of patients .RIPer group was treated with three circles of 5-minute ischemia and 5-minute reperfusion for lower left limb immediately at the clamping of aorta ..Group C group was not treated .Carotid ve-nous blood was collected before anesthesia induction （d0 ） ,d1 ,d3 and d7 after operation .Serum alamine transami-nase（ALT） ,glutamate transaminase（AST） ,total bilirubin（TBIL） and total bile acid（TBA） were measured .Su-peroxide dismutase（SOD） activity 24h before and after RIPer .Results]Serum ALT and AST in two groups after operation were increased in different degree .ALT level in RIPer group at d1 ,d3 and d7 after operation was lower than that in group C （ P 〈0 .05） .AST level in RIPer group at d2 and d3 after operation was lower than that in group C（ P 〈0 .05） ,but there was no significant difference in AST level at d7 between two groups（ P 〉0 .05） . There was no significant difference in TBIL and TBA level at d1 ,d3 and d7 after operation between two groups . Plasma SOD activity in RIPer group 24h after RIPer was obviously higher than that in control group .Conclusion]RIPer can reduce acute liver injury after cardiopulmonary bypass ,but has little impact on liver reserve function . SOD might participate in the protective effect of RIPer .