氯胺酮对先天性心脏病患者心内直视手术下心肌热休克蛋白72 mRNA表达的影响

目的 研究人全心缺血再灌注时心肌热休克蛋白72(HSP72)mRNA的表达及氯胺酮预处理对其表达的影响,探讨氯胺酮心肌保护的机制.方法 选择择期行先天性房间隔缺损或室间隔缺损修补术的患者36人,随机分为3组(各12人):对照组(C组)、氯胺酮干预组(K1、K2组).在劈胸骨、主动脉插管时和主动脉开放前5 min,干预组分别静脉注射氯胺酮0.5、1.0mg/kg,对照组注射等量生理盐水.在上腔静脉插管时(T1)、主动脉阻断后30 min(T2)和主动脉开放后30 min(T3)取适量心肌组织,应用一步法实时荧光定量逆转录一聚合酶链反应检测心肌中HSP72 mRNA的表达量.结果 组内比较HSP72mRNA表达量随着缺血再灌注损伤的发生和发展呈逐渐增加的趋势,各时间点比较差异有统计学意义(P＜0.05).组间比较除T1时间点外,HSP72 mRNA表达量在T2和T3时间点氯胺酮干预组均显著高于对照组(P＜0.05),K1、K2两组相比较差异无显著性(P＞0.05).结论 HSP72基因在心肌缺血再灌注损伤时表达增加.氯胺酮能显著促进心肌HSP72基因的表达,减少血浆心肌酶的漏出,具有心肌保护作用,且亚麻醉剂量与麻醉剂量效应相同.

Effects of ketamine on the expression of myocardial heat shock protein 72 mRNA in congenital heart disease patients undergoing cardiac surgery

Objectives By detecting the expression of myocardial heat shock protein 72(HSP72) mRNA during cardiac surgery under cardio-pulmonary bypass,and studying the effects of ke- tamine on the expression of HSP72 to investigate the mechanisms of myocardial protection by ketamine.Methods 36 patients undergoing atrial or ventricular septal defect correction opera- tions were chosen,and were randomly allocated in 3 groups(12 patients for each):control and ketamine interfered groups(K_1 and K_2 group).Ketamine,0.5 and...