远隔缺血时处理对体外循环瓣膜置换术患者肾损伤的影响

【目的】观察远隔缺血时处理对体外循环（CPB）瓣膜置换术患者尿中性粒细胞明胶酶相关性脂质运载蛋白（NGAL）和肾损伤分子l（KIM-1）的影响。【方法】择期CPB下瓣膜置换术患者60例，随机分为两组（n=30）：远隔缺血时处理组（R组）和对照组（c组）。R组在主动脉阻断同时对患者右下肢实施3周期5min缺血／5min再灌注处理；C组不进行该处理。分别于术前（T0）、CPB结束后2h（T1）、6h（T2）、12h（T3）、24h（T4）和48h（T5）6个时间点检测尿NGAL、KIM-1和血肌酐（SCr）的水平，记录各时间段尿量。【结果】与C组相比，R组尿NGAL在T1，T2、T3、T4较低，KIM-1在T2、T3、T4较低，尿量在T1～2，T2～3时间段较多（P〈0．05）；与T0相比，两组患者尿NGAL在T1～T4明显升高，KIM-1在T2～T5明显升高，SCr在T5明显升高（P〈0．05）。【结论】远隔缺血时处理可降低瓣膜置换术患者尿NGAL和KIM1的水平，对CPB后肾损伤有一定的保护作用。

Effect of Remote Ischemic Preconditioning on Kidney Injury in Patients Undergoing Valve Replace- ment Surgery with Cardiopulmonary Bypass

[Objective] To observe the effect of remote ischemic preconditioning on urinary neutrophil gelatinase-asso- dated lipocalin（NGAL） and kidney injury molecule-1 （KIM-1） in patients undergoing valve replacement surgery with cardiopulmonary bypass（CPB）. [Methods] Totally 60 patients scheduled for valve replacement with CPB were randomly divided into remote ischemic preconditioning（group R, n= 30） and control group（group C. n= 30）. Group R received aortic occlusion and 3 cycles of 5-min ischemia and 5-min reperfusion conditioning on right lower limb, while group C did not received the treatment. NGAL and KIM-1 in urine and serum creatinine（SCr） were detected before surgery（T0）, 2h（T1 ）, 6h（T2）, 12h（T3 ）, 24h（T4 ） and 48h（Ts ） after CPB ending point. Urine volume was recorded at each time point. [Results] Compared with group C, urine NGAL at T1 , T2, T3, and T4 were lower, and KIM-1 at T2, Ta and T4 were lower, and urine volume at T1-2 and T2-3 were larger in group R（ P〈0.05）. Compared with To , urine NGAL at T1- T5, KIM-1 at T3-T5 and SCr at T5 were obviously increased in two groups（ P 〈0.05）. [Conclusion] Remote ischemic perconditioning can reduce the levels of urine NGAL and KIM-1 in patients undergoing valve replacement with CPB, and has certain protective effect on kidney injury after CPB.